Making the case for a model mental health advance directive statute.

PubMed

Clausen, Judy A

2014-01-01

Acute episodes of mental illness temporarily destroy the capacity required to give informed consent and often prevent people from realizing they are sick, causing them to refuse intervention. Once a person refuses treatment, the only way to obtain care is as an involuntary patient. Even in the midst of acute episodes, many people do not meet commitment criteria because they are not likely to injure themselves or others and are still able to care for their basic needs. Left untreated, the episode will likely spiral out of control. By the time the person finally meets strict commitment criteria, devastation has already occurred. This Article argues that an individual should have the right to enter a Ulysses arrangement, a special type of mental health advance directive that authorizes a doctor to administer treatment during a future episode even if the episode causes the individual to refuse care. The Uniform Law Commissioners enacted the Uniform Health-Care Decisions Act as a model statute to address all types of advance health care planning, including planning for mental illness. However, the Act focuses on end-of-life care and fails to address many issues faced by people with mental illness. For example, the Act does not empower people to enter Ulysses arrangements and eliminates writing and witnessing requirements that protect against fraud and coercion. This Article recommends that the Uniform Law Commissioners adopt a model mental health advance directive statute that empowers people to enter Ulysses arrangements and provides safeguards against abuse. Appendix A sets forth model provisions.

A Korean perspective on developing a global policy for advance directives.

PubMed

Kim, Soyoon; Hahm, Ki-Hyun; Park, Hyoung Wook; Kang, Hyun Hee; Sohn, Myongsei

2010-03-01

Despite the wide and daunting array of cross-cultural obstacles that the formulation of a global policy on advance directives will clearly pose, the need is equally evident. Specifically, the expansion of medical services driven by medical tourism, just to name one important example, makes this issue urgently relevant. While ensuring consistency across national borders, a global policy will have the additional and perhaps even more important effect of increasing the use of advance directives in clinical settings and enhancing their effectiveness within each country, regardless of where that country's state of the law currently stands. One cross-cultural issue that may represent a major obstacle in formulating, let alone applying, a global policy is whether patient autonomy as the underlying principle for the use of advance directives is a universal norm or a construct of western traditions that must be reconciled with alternative value systems that may place lesser significance on individual choice. A global policy, at a minimum, must emphasize respect for patient autonomy, provision of medical information, limits to the obligations for physicians, and portability. And though the development of a global policy will be no easy task, active engagement in close collaboration with the World Health Organization can make it possible.

Advance care planning in Australia: what does the law say?

PubMed

Carter, Rachel Z; Detering, Karen M; Silvester, William; Sutton, Elizabeth

2016-09-01

Advance care planning (ACP) assists people to plan for their future health and personal care. ACP encourages a person to legally appoint a substitute decision maker (SDM) and to document any specific wishes regarding their future health care in an advance care directive (ACD). Formal documentation of wishes increases the chances that a person's wishes will be known and followed. However, one of the biggest impediments for doctors following the person's wishes is uncertainty surrounding the law, which is complicated and varies between the states and territories of Australia. SDM legislation varies regarding who can be appointed, how they are appointed, the powers that an SDM can be given and the decision-making principles that the SDM needs to follow. In circumstances where an SDM has not been appointed, the hierarchy for determining the default SDM for a person also varies between states. Although many states have legislated ACD forms allowing for documentation of a person's health care wishes, these forms allow for different things to be documented and have different requirements to be valid. The Australian population is mobile, with patients frequently moving between states. The status of ACP documentation created in a state other than the state in which a patient requires treatment also varies, with some states recognising interstate ACDs whereas others do not. This article outlines the legal status of ACDs, within Australian jurisdictions, including the legal validity of interstate ACDs, and argues that uniform laws and documents would assist with awareness and understanding of, and compliance with, ACDs.

A Randomized Controlled Trial Comparing the Letter Project Advance Directive to Traditional Advance Directive.

PubMed

Periyakoil, Vyjeyanthi S; Neri, Eric; Kraemer, Helena

2017-09-01

Simpler alternatives to traditional advance directives that are easy to understand and available in multiple formats and can be initiated by patients and families will help facilitate advance care planning. The goal of this study was to compare the acceptability of the letter advance directive (LAD) to the traditional advance directive (TAD) of the state of California. A web-based, randomized controlled trial was conducted, in which the participants were randomized to one of two types of advance directives (ADs): the LAD (intervention) or the TAD (control). Primary outcomes were participant ratings of the ease, value, and their level of comfort in the AD document they completed. A total of 400 participants completed the study, with 216 randomized to the LAD and 184 to the TAD by a computerized algorithm. Overall, participants preferred the LAD to the TAD (success rate difference [SRD] = 0.46, 95th percentile confidence interval [CI]: 0.36-0.56, p < 0.001). The participants felt that, compared to the TAD, the LAD was easier to read and understand (SRD = 0.56, CI: 0.47-0.65, p < 0.001); better reflected what matters most to them (SRD = 0.39, CI: 0.29-0.48, p < 0.001); helped stimulate their thinking about the types of treatments they wanted at the end of life (SRD = 0.32, CI: 0.23-0.42, p < 0.001); allowed them to describe how they made medical decisions in their family (SRD = 0.31, CI: 0.21-0.40, p < 0.001); and could help their doctor(s) (SRD = 0.24, CI: 0.13-0.34, p < 0.001) and their families (SRD = 0.19, CI: 0.08-0.28, p < 0.001) understand their end-of-life treatment preferences. Patients reported the letter advance directive to be a better alternative to the traditional advance directive form.

Health Care Providers’ Attitudes and Practices Regarding the use of Advance Directives in a Military Health Care Setting

DTIC Science & Technology

1998-10-02

PROVIDERS’ ATTITUDES AND PRACTICES REGARDING THE USE OF ADVANCE DIRECTIVES IN A MILITARY HEALTH CARE SETTING by Bridget L. Larew, Maj, USAF, NC Thesis...entitled: "HEALTH CARE PROVIDER’S ATTITUDES AND PRACTICES REGARDING THE PURPOSE AND USE OF ADVANCE DIRECTIVES IN A MILITARY HEALTH CARE SETTING" beyond...health care, recognized under State law (whether statutory or as recognized by the courts of the State) and relating to the provision of such care

Advance directives and living wills.

PubMed Central

Stewart, K.; Bowker, L.

1998-01-01

Under certain circumstances, living wills or advance directives may carry legal force in the UK. This paper traces the development of advance directives, clarifies their current legal position and discusses potential problems with their use. Case histories are used to illustrate some of the common dilemmas which doctors may face. PMID:9640440

[Advance directives in patients with kidney disease or other general medical diagnoses].

PubMed

Driehorst, F; Keller, F

2014-03-01

After the law on living will was released in 2009 in Germany, an increased use of advance directives was observed. Since patients with kidney diseases are facing the potential or real need for expensive and invasive renal replacement therapy, one could speculate that they will either less or even more frequently state an advance directive than patients with other diseases. A structured interviewing was performed of all patients on a nephrology ward where also patients with other general medical conditions are treated. The study was approved by our local ethics committee (protocol # 303/08). All admitted patients were successively included who could give signed consent. The investigation was performed between July 2009 and April 2010 by a single interviewer (FD). Among 505 admitted patients, 211 were included but 11 patients did not consent to the investigation. Of the 200 investigated patients, 121 had a renal diagnosis and 79 other medical diseases. Compared to other European studies, the frequency of advance directives was high (26 %), underlining its clinical relevance. Upon multivariate logistic regression analysis the odds ratio (95 % confidence interval, CI) for the presence of an advance directive was significantly increased only by the age (1.06; CI 1.03-1.09; p = 0.001), but not by the underlying diagnosis (1.47; CI 0.72-2.97; p = 0.287). Significantly more patients did forego resuscitation than did dialysis in their living will (16 vs. 4) while the majority was undecided (36 vs. 47; p = 0.01). Age was found the more impacting variable than the renal diagnosis on the prevalence of advance directives. Patients with a renal diagnosis should be encouraged to make a statement on dialysis in their living will. © Georg Thieme Verlag KG Stuttgart · New York.

Advance directives: survey of primary care patients.

PubMed

O'Sullivan, Rory; Mailo, Kevin; Angeles, Ricardo; Agarwal, Gina

2015-04-01

To establish the prevalence of patients with advance directives in a family practice, and to describe patients' perspectives on a family doctor's role in initiating discussions about advance directives. A self-administered patient questionnaire. A busy urban family medicine teaching clinic in Hamilton, Ont. A convenience sample of adult patients attending the clinic over the course of a typical business week. The prevalence of advance directives in the patient population was determined, and the patients' expectations regarding the role of their family doctors were elucidated. The survey population consisted of 800 participants (a response rate of 72.5%) well distributed across age groups; 19.7% had written advance directives and 43.8% had previously discussed the topic of advance directives, but only 4.3% of these discussions had occurred with family doctors. In 5.7% of cases, a family physician had raised the issue; 72.3% of respondents believed patients should initiate the discussion. Patients who considered advance directives extremely important were significantly more likely to want their family doctors to start the conversation (odds ratio 3.98; P < .05). Advance directives were not routinely addressed in the family practice. Most patients preferred to initiate the discussion of advance directives. However, patients who considered the subject extremely important wanted their family doctors to initiate the discussion. Copyright© the College of Family Physicians of Canada.

Advance Directives in Some Western European Countries: A Legal and Ethical Comparison between Spain, France, England, and Germany.

PubMed

Veshi, Denard; Neitzke, Gerald

2015-09-01

We have studied national laws on advance directives in various Western European countries: Romance-speaking countries (Italy, France, Portugal, and Spain), English-speaking countries (Ireland and the United Kingdom), and German-speaking countries (Austria, Germany, and Switzerland). We distinguish two potentially complementary types of advance medical declaration: the 'living will' and the nomination of a legal proxy. After examining the similarities and differences between countries, we analyse in detail the legislation of four countries (Spain, France, England, and Germany), since the other countries in this survey have similar legal principles and/or a similar political approach. In conclusion, we note that in all the countries examined, advance directives have been seen as an instrument to enable the patient's right to self-determination. Notwithstanding, in Romance-speaking countries, the involvement of physicians in the end-of-life process and risks arising from the execution of advance directives were also considered.

Personhood, patienthood, and clinical practice: reassessing advance directives.

PubMed

Rich, B A

1998-09-01

This article considers 2 major critiques of advance directives and offers a defense to each of them. The 1st critique is philosophical in nature and maintains that the moral authority of an advance directive is undercut by a failure of personal identity to survive the loss of decisional capacity. The response in this article is that this critique relies on a flawed and disfavored concept of persons and their persistence over time. The 2nd critique, pragmatic in nature, argues that advance directives cannot be authoritative because the requisite elements of an informed consent to or refusal of treatment are rarely present, and many such instruments are ambiguous. The author argues that if the creation of advance directives, as a form of advance care planning, is made an integral aspect of clinical practice, many more patients will elect to execute directives, and those directives will not be ambiguous.

[Advance directives. Representatives' opinions].

PubMed

Busquets I Font, J M; Hernando Robles, P; Font I Canals, R; Diestre Ortin, G; Quintana, S

The use and usefulness of Advance Directives has led to a lot of controversy about their validity and effectiveness. Those areas are unexplored in our country from the perspective of representatives. To determine the opinion of the representatives appointed in a registered Statement of Advance Directives (SAD) on the use of this document. Telephone survey of representatives of 146 already dead people and who, since February 2012, had registered a SAD document. More the two-thirds (98) of respondents recalled that the SAD was consulted, with 86 (58.9%) saying that their opinion as representative was consulted, and 120 (82.1%) believe that the patient's will was respected. Of those interviewed, 102 (69.9%) believe that patients who had previously planned their care using a SAD had a good death, with 33 (22.4%) saying it could have been better, and 10 (6.9%) believe they suffered greatly. The SAD were mostly respected and consulted, and possibly this is related to the fact that most of the representatives declare that the death of those they represented was perceived as comfortable. It would be desirable to conduct further studies addressed at health personnel in order to know their perceptions regarding the use of Advance Directives in the process of dying. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

[New italian law about end of life: self-determination and shared care pathway.

PubMed

Ciliberti, Rosagemma; Gulino, Matteo; Gorini, Ilaria

2018-05-01

The Italian Parliament has recently approved the Law n. 219/2017 concerning "Rules on informed consent and advance directives". The manuscript points out the main key points of the new law, in order to clarify the role of the advance directives and to provide clear operational guidelines for healthcare personnel. Taking into consideration the Italian deontological and juridical context, along with the main jurisprudential judgements, the law has been analysed. The Authors discussed the new rules and the bioethical issues also in relation to the provisions stated by the Convention on Human Rights and Biomedicine (Convention of Oviedo). The new law deals with relevant issues that were confined to jurisprudential rulings so far, such as the informed consent, the withdrawal/withholding of medical treatment (including artificial nutrition and hydration), the content of medical information, including the modalities, the medical responsibility and, finally, the value of advance directives. In the Authors' opinion this law provides essential rules to expressly strengthen the patients' autonomy, eliminating the juridical uncertainty on many central issues (such us, for example, the refusal of life-sustainment treatments) that have been the subject of contradictory judgments ruled by the Italian Courts. Nevertheless, advance directives should be regarded as a dynamic tools of relationship between physicians and assisted person and, thus, as an essential integrant part of the advance care planning. The education of health professionals and citizens about end of life issues is the basis for the successful implementation of this legislation.

The role of advance directives in end-of-life decisions in Austria: survey of intensive care physicians.

PubMed

Schaden, Eva; Herczeg, Petra; Hacker, Stefan; Schopper, Andrea; Krenn, Claus G

2010-10-21

Currently, intensive care medicine strives to define a generally accepted way of dealing with end-of-life decisions, therapy limitation and therapy discontinuation.In 2006 a new advance directive legislation was enacted in Austria. Patients may now document their personal views regarding extension of treatment. The aim of this survey was to explore Austrian intensive care physicians' experiences with and their acceptance of the new advance directive legislation two years after enactment (2008). Under the aegis of the OEGARI (Austrian Society of Anaesthesiology, Resuscitation and Intensive Care) an anonymised questionnaire was sent to the medical directors of all intensive care units in Austria. The questions focused on the physicians' experiences regarding advance directives and their level of knowledge about the underlying legislation. There were 241 questionnaires sent and 139 were turned, which was a response rate of 58%. About one third of the responders reported having had no experience with advance directives and only 9 directors of intensive care units had dealt with more than 10 advance directives in the previous two years. Life-supporting measures, resuscitation, and mechanical ventilation were the predominantly refused therapies, wishes were mainly expressed concerning pain therapy. A response rate of almost 60% proves the great interest of intensive care professionals in making patient-oriented end-of-life decisions. However, as long as patients do not make use of their right of co-determination, the enactment of the new law can be considered only a first important step forward.

Predictors of advance directives among nursing home residents with dementia.

PubMed

Huang, Hsiu-Li; Shyu, Yea-Ing Lotus; Weng, Li-Chueh; Chen, Kang-Hua; Hsu, Wen-Chuin

2018-03-01

ABSTRACTBackground:Advance directives are important for nursing home residents with dementia; for those with advanced dementia, surrogates determine medical decisions. However, in Taiwan, little is known about what influences the completion of these advance directives. The purpose of this study was to identify factors, which influence the presence of advance directives for nursing home residents with dementia in Taiwan. Our cross-sectional study analyzed a convenience sample of 143 nursing home dyads comprised of residents with dementia and family surrogates. Documentation of residents' advance directives, physical and cognitive status was obtained from medical charts. Surrogates completed the stress of end-of-life care decision scale and a questionnaire regarding their demographic characteristics. Nursing home characteristics were obtained from each chief administrator. Less than half of the nursing home residents (39.2%) had advance directives and most (96.4%) had been completed by family surrogates. The following were predictors of an advance directive: surrogates had previously signed a do-not-resuscitate as a proxy and had been informed of advance directives by a healthcare provider; nursing homes had policies for advance directives and a religious affiliation. Advance directives were uncommon for nursing home residents with dementia. Presence of an advance directive was associated with surrogate characteristics and the nursing home facilities; there was no association with characteristics of the nursing home resident. Our findings emphasize the need to develop policies and strategies, which ensure that all residents of nursing homes and their surrogates are aware of their right to an advance directive.

High-Alpha Research Vehicle Lateral-Directional Control Law Description, Analyses, and Simulation Results

NASA Technical Reports Server (NTRS)

Davidson, John B.; Murphy, Patrick C.; Lallman, Frederick J.; Hoffler, Keith D.; Bacon, Barton J.

1998-01-01

This report contains a description of a lateral-directional control law designed for the NASA High-Alpha Research Vehicle (HARV). The HARV is a F/A-18 aircraft modified to include a research flight computer, spin chute, and thrust-vectoring in the pitch and yaw axes. Two separate design tools, CRAFT and Pseudo Controls, were integrated to synthesize the lateral-directional control law. This report contains a description of the lateral-directional control law, analyses, and nonlinear simulation (batch and piloted) results. Linear analysis results include closed-loop eigenvalues, stability margins, robustness to changes in various plant parameters, and servo-elastic frequency responses. Step time responses from nonlinear batch simulation are presented and compared to design guidelines. Piloted simulation task scenarios, task guidelines, and pilot subjective ratings for the various maneuvers are discussed. Linear analysis shows that the control law meets the stability margin guidelines and is robust to stability and control parameter changes. Nonlinear batch simulation analysis shows the control law exhibits good performance and meets most of the design guidelines over the entire range of angle-of-attack. This control law (designated NASA-1A) was flight tested during the Summer of 1994 at NASA Dryden Flight Research Center.

The role of advance directives in end-of-life decisions in Austria: survey of intensive care physicians

PubMed Central

2010-01-01

Background Currently, intensive care medicine strives to define a generally accepted way of dealing with end-of-life decisions, therapy limitation and therapy discontinuation. In 2006 a new advance directive legislation was enacted in Austria. Patients may now document their personal views regarding extension of treatment. The aim of this survey was to explore Austrian intensive care physicians' experiences with and their acceptance of the new advance directive legislation two years after enactment (2008). Methods Under the aegis of the OEGARI (Austrian Society of Anaesthesiology, Resuscitation and Intensive Care) an anonymised questionnaire was sent to the medical directors of all intensive care units in Austria. The questions focused on the physicians' experiences regarding advance directives and their level of knowledge about the underlying legislation. Results There were 241 questionnaires sent and 139 were turned, which was a response rate of 58%. About one third of the responders reported having had no experience with advance directives and only 9 directors of intensive care units had dealt with more than 10 advance directives in the previous two years. Life-supporting measures, resuscitation, and mechanical ventilation were the predominantly refused therapies, wishes were mainly expressed concerning pain therapy. Conclusion A response rate of almost 60% proves the great interest of intensive care professionals in making patient-oriented end-of-life decisions. However, as long as patients do not make use of their right of co-determination, the enactment of the new law can be considered only a first important step forward. PMID:20964852

Advance directives in intensive care: Health professional competences.

PubMed

Velasco-Sanz, T R; Rayón-Valpuesta, E

2016-04-01

To identify knowledge, skills and attitudes among physicians and nurses of adults' intensive care units (ICUs), referred to advance directives or living wills. A cross-sectional descriptive study was carried out. Nine hospitals in the Community of Madrid (Spain). Physicians and nurses of adults' intensive care. A qualitative Likert-type scale and multiple response survey were made. Knowledge, skills and attitudes about the advance directives. A descriptive statistical analysis based on percentages was made, with application of the chi-squared test for comparisons, accepting p < 0.05 as representing statistical significance. A total of 331 surveys were collected (51%). It was seen that 90.3% did not know all the measures envisaged by the advance directives. In turn, 50.2% claimed that the living wills are not respected, and 82.8% believed advance directives to be a useful tool for health professionals in the decision making process. A total of 85.3% the physicians stated that they would respect a living will, in cases of emergencies, compared to 66.2% of the nursing staff (p = 0.007). Lastly, only 19.1% of the physicians and 2.3% of the nursing staff knew whether their patients had advance directives (p < 0.001). Although health professionals displayed poor knowledge of advance directives, they had a favorable attitude toward their usefulness. However, most did not know whether their patients had a living will, and some professionals even failed to respect such instructions despite knowledge of the existence of advance directives. Improvements in health professional education in this field are needed. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

Advance directives and personal identity: what is the problem?

PubMed

Furberg, Elisabeth

2012-02-01

The personal identity problem expresses the worry that due to disrupted psychological continuity, one person's advance directive could be used to determine the care of a different person. Even ethicists, who strongly question the possibility of the scenario depicted by the proponents of the personal identity problem, often consider it to be a very potent objection to the use of advance directives. Aiming to question this assumption, I, in this paper, discuss the personal identity problem's relevance to the moral force of advance directives. By putting the personal identity argument in relation to two different normative frameworks, I aim to show that whether or not the personal identity problem is relevant to the moral force of advance directives, and further, in what way it is relevant, depends entirely on what normative reasons we have for respecting advance directives in the first place.

Advance directives: cancer patients' preferences and family-based decision making.

PubMed

Xing, Yan-Fang; Lin, Jin-Xiang; Li, Xing; Lin, Qu; Ma, Xiao-Kun; Chen, Jie; Wu, Dong-Hao; Wei, Li; Yin, Liang-Hong; Wu, Xiang-Yuan

2017-07-11

Advance directives are a sensitive issue among traditional Chinese people, who usually refrain from mentioning this topic until it is imperative. Medical decisions for cancer patients are made by their families, and these decisions might violate patients' personal will. This study aimed to examine the acceptance of advance directives among Chinese cancer patients and their families and patient participation in this procedure and, finally, to analyze the moral risk involved. While 246 patients and their family members refused official discussion of an advance directive, the remaining 166 patients and their families accepted the concept of an advance directive and signed a document agreeing to give up invasive treatment when the anti-cancer treatment was terminated. Of these, only 24 patients participated in the decision making. For 101 patients, anti-cancer therapy was ended prematurely with as many as 37 patients not told about their potential loss of health interests. Participants were 412 adult cancer patients from 9 leading hospitals across China. An advance directive was introduced to the main decision makers for each patient; if they wished to sign it, the advance directive would be systematically discussed. A questionnaire was given to the oncologists in charge of each patient to evaluate the interaction between families and patients, patients' awareness of their disease, and participation in an advance directive. Advance directives were not widely accepted among Chinese cancer patients unless anti-cancer therapy was terminated. Most cancer patients were excluded from the discussion of an advance directive.

Advance Directives - Multiple Languages

MedlinePlus

... List of All Topics All Advance Directives - Multiple Languages To use the sharing features on this page, please enable JavaScript. Arabic (العربية) ... Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of Health Page last updated on 7 December 2017

Laser Atmospheric Wind Sounder (LAWS) phase 1. Volume 1: Executive summary

NASA Technical Reports Server (NTRS)

1990-01-01

The laser atmospheric wind sounder (LAWS) will provide a new space based capability for the direct measurement of atmospheric winds in the troposphere. LAWS will make a major contribution toward advancing the understanding and prediction of the total Earth system and NASA's Earth Observing System (EOS) Program. LAWS is designed to measure a fundamental atmospheric parameter required to advance weather forecasting accuracies and investigate global climatic change. LAWS has a potential added benefit of providing (global) concentration profiles of large aerosols including visible and subvisible cirrus clouds, volcanic dust, smoke, and other pollutants. The objective of this Phase One study was to develop a LAWS concept and configuration. The instrument design is outlined in this first volume of three.

Family structure, experiences with end-of-life decision making, and who asked about advance directives impacts advance directive completion rates.

PubMed

Van Scoy, Lauren J; Howrylak, Judie; Nguyen, Anhthu; Chen, Melodie; Sherman, Michael

2014-10-01

Advance directives are an important but underutilized resource. Reasons for this underutilization need to be determined. We investigated factors associated with completion of advance directives among inpatients. We conducted prospective, structured interviews on family structure, health care, disease, and end-of-life experiences. We compared those with completed advance directives and those without. We interviewed 130 inpatients in an urban university hospital. We used bivariate analysis and logistic regression to identify characteristics of patients with living wills and health care proxies versus patients without them. Twenty-one percent of patients had a living will and 35% had a health care proxy. Patients with completed living wills were older (p≤0.0046), had more comorbidities (p=0.018), were widowed (p=0.02), and were more often admitted with chronic disease (p=0.009) compared to those without living wills. Patients with health care proxies were older (p<0.001), had religious affiliations (p=0.04), more children (p=0.03), and more often widowed (p≤0.001) than those without health care proxies. Patients were 10.8 times (95% confidence interval [CI] 4.59-25.3), 46.5 times (95% CI 15.1-139.4), and 68.6 times (95% CI 13.0-361.3) more likely to complete a living will when asked by medical staff, legal staff, or family and friends, respectively, than those not asked. Patients with health care proxies were 1.68 times (95% CI 0.81-3.47), 4.34 times (95% CI 1.50-12.6), and 18.0 times (95% CI 2.03-158.8) more likely to have been asked by the same groups. Patients with experience in end-of-life decision-making were 2.54 times more likely to possess a living will (95%CI 1.01-6.42) and 3.53 times more likely to possess a health care proxy (95% CI 1.51-8.25) than those without experiences. Having been asked about advance directives by medical staff, legal staff, or family and friends increases the likelihood that patients will possess an advance directive. Those with

[Advance directives and advance care planning].

PubMed

Vayne-Bossert, Petra; Vailloud, Christiane; Ducloux, Dominique; Matis, Caroline; Déramé, Laurence

2017-02-01

Advance directives (AD) and Advance Care Planning (ACP) are two measures a person may undertake to assure that their treatment preferences will be respected until the end of his / her life. Anticipation is based on an open and honest communication between the patient, the durable medical power of attorney and the health care professionals. ADs and ACPs are based on a person's values and beliefs that are important to his quality of life. ACP is a continuing process, initiated by health care professionals and integrated into the health care plan of a person. It should be adjusted all along the disease trajectory and favors communication and anticipation in the health care network. ADs are often a personal initiative to ensure one's wishes in relation to health issues. In Switzerland, they are based on a legal framework and their application is therefore mandatory for health care professionals.

How strictly do dialysis patients want their advance directives followed?

PubMed

Sehgal, A; Galbraith, A; Chesney, M; Schoenfeld, P; Charles, G; Lo, B

1992-01-01

The Cruzan case and the Patient Self-Determination Act will encourage patients to specify in advance which life-sustaining treatments they would want if they become mentally incompetent. However, strictly following such advance directives may not always be in a patient's best interests. We sought to determine whether patients differ in how strictly they want advance directives followed. Interview study. Seven outpatient chronic dialysis centers. One hundred fifty mentally competent dialysis patients. Using a structured questionnaire, we asked the subjects whether they would want dialysis continued or stopped if they developed advanced Alzheimer's disease. We then asked how much leeway their physician and surrogate should have to override that advance directive if overriding were in their best interests. Subjects granting leeway were also asked what factors should be considered in making decisions for them. Subjects varied greatly in how much leeway they would give surrogates to override their advance directives: "no leeway" (39%), "a little leeway" (19%), "a lot of leeway" (11%), and "complete leeway" (31%). Subjects also varied in how much they wanted various factors considered in making decisions, such as pain or suffering, quality of life, possibility of a new treatment, indignity caused by continued treatment, financial impact of treatment on family members, and religious beliefs. Strictly following all advance directives may not truly reflect patients' preferences. To improve advance directives, we recommend that physicians explicitly ask patients how strictly they want their advance directives followed and what factors they want considered in making decisions.

Cross-border healthcare: Directive 2011/24 and the Greek law.

PubMed

Vidalis, Takis; Kyriakaki, Irini

2014-03-01

The Greek legal framework on healthcare is characterized by the complexity of an immense number of laws and regulatory acts, particularly regarding the national health system. In the face front of that problem, the Directive stands as an effort (and an opportunity) to achieve a regulatory rationalization. The Law 3918/2011 established the National Organisation for Healthcare (EOPYY). EOPYY is the unique national contact point in the country for the purposes of the Directive, having a responsibility to ensure that the services provided by its affiliated healthcare providers meet certain quality and safety standards. Furthermore, the Greek legal system encompasses an integrated body of legislation on informed consent, privacy, and data protection, as well as an explicit reference to the 'quality, safety and efficiency' of medical services, and provisions related to reimbursement issues that need further regulatory specification.

Autonomy and the Moral Authority of Advance Directives.

PubMed

Vogelstein, Eric

2016-10-01

Although advance directives are widely believed to be a key way to safeguard the autonomy of incompetent medical patients, significant questions exist about their moral authority. The main philosophical concern involves cases in which an incompetent patient no longer possesses the desires on which her advance directive was based (e.g., in cases of severe dementia). The question is, does that entail that prior expressions of medical choices are no longer morally binding? I believe that the answer is "yes." I argue that a patient's autonomy is not respected by honoring the desires she used to have but no longer does. I also consider and reject the view that honoring an advance directive that reflects the patient's previous values must be in that patient's best interests. If that is correct, then advance directives in the kind of case at issue are not morally binding. © The Author 2016. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Inapplicability of advance directives in a paternalistic setting: the case of a post-communist health system

PubMed Central

2011-01-01

Background The Albanian medical system and Albanian health legislation have adopted a paternalistic position with regard to individual decision making. This reflects the practices of a not-so-remote past when state-run facilities and a totalitarian philosophy of medical care were politically imposed. Because of this history, advance directives concerning treatment refusal and do-not-resuscitate decisions are still extremely uncommon in Albania. Medical teams cannot abstain from intervening even when the patient explicitly and repeatedly solicits therapeutic abstinence. The Albanian law on health care has no provisions regarding limits or withdrawal of treatment. This restricts the individual's healthcare choices. Discussion The question of 'medically futile' interventions and pointless life-prolonging treatment has been discussed by several authors. Dutch physicians call such interventions 'medisch zinloos' (senseless), and the Netherlands, as one of the first states to legislate on end-of-life situations, actually regulates such issues through appropriate laws. In contrast, leaving an 'advance directive' is not a viable option for Albanian ailing individuals of advanced age. Verbal requests are provided during periods of mental competence, but unfortunately such instructions are rarely taken seriously, and none of them has ever been upheld in a legal or other official forum. Summary End-of-life decisions, treatment refusal and do-not-resuscitate policies are hazardous options in Albania, from the legal point of view. Complying with them involves significant risk on the part of the physician. Culturally, the application of such instructions is influenced from a mixture of religious beliefs, death coping-behaviors and an immense confusion concerning the role of proxies as decision-makers. Nevertheless, Albanian tradition is familiar with the notion of 'amanet', a sort of living will that mainly deals the property and inheritance issues. Such living wills, verbally

Advance Directives in Hospice Healthcare Providers: A Clinical Challenge.

PubMed

Luck, George R; Eggenberger, Terry; Newman, David; Cortizo, Jacqueline; Blankenship, Derek C; Hennekens, Charles H

2017-11-01

On a daily basis, healthcare providers, especially those dealing with terminally ill patients, such as hospice workers, witness how advance directives help ensure the wishes of patients. They also witness the deleterious consequences when patients fail to document the care they desire at their end of life. To the best of our knowledge there are no data concerning the prevalence of advance directives among hospice healthcare providers. We therefore explored the prevalence and factors influencing completion rates in a survey of hospice healthcare providers. Surveys that included 32 items to explore completion rates, as well as barriers, knowledge, and demographics, were e-mailed to 2097 healthcare providers, including employees and volunteers, at a nonprofit hospice. Of 890 respondents, 44% reported having completed an advance directive. Ethnicity, age, relationship status, and perceived knowledge were all significant factors influencing the completion rates, whereas years of experience or working directly with patients had no effect. Procrastination, fear of the subject, and costs were common reasons reported as barriers. Upon completion of the survey, 43% said they will now complete an advance directive, and 45% will talk to patients and families about their wishes. The majority of hospice healthcare providers have not completed an advance directive. These results are very similar to those for other healthcare providers treating patients with terminal diseases, specifically oncologists. Because, at completion, 43% said that they would now complete an advance directive, such a survey of healthcare providers may help increase completion rates. Copyright © 2017 Elsevier Inc. All rights reserved.

Completing advance directives for health care decisions: getting to yes.

PubMed

Shewchuk, T R

1998-09-01

The concept of advance directives for health care decision making has been judicially condoned, legislatively promoted, and systematically implemented by health care institutions, yet the execution rate of advance directives remains low. Physicians should discuss with their patients advance care planning generally and end-of-life issues specifically, preferably when patients are in good health and not when they face an acute medical crisis. The physician-hospital relationship poses particular challenges for the optimal implementation of advance directives that must be addressed. Hospital administrators must improve education of patients and physicians on the value of such documents as well as internal mechanisms to ensure better implementation of directives. Health insurance plans may be better able to ensure optimal gathering and implementation of directives. Patients must become more familiar and more comfortable with advance care planning and the reality of death and dying issues. Full acceptance of the value of directives ultimately rests on achieving full participation of all involved--providers, patients, families, and payors--in this most profound process.

Advance Health Care Directives and “Public Guardian”: The Italian Supreme Court Requests the Status of Current and Not Future Inability

PubMed Central

Busardò, Francesco Paolo; Bello, Stefania; Gulino, Matteo; Zaami, Simona; Frati, Paola

2014-01-01

Advance health care decisions animate an intense debate in several European countries, which started more than 20 years ago in the USA and led to the adoption of different rules, based on the diverse legal, sociocultural and philosophical traditions of each society. In Italy, the controversial issue of advance directives and end of life's rights, in the absence of a clear and comprehensive legislation, has been over time a subject of interest of the Supreme Court. Since 2004 a law introduced the “Public Guardian,” aiming to provide an instrument of assistance to the person lacking in autonomy because of an illness or incapacity. Recently, this critical issue has once again been brought to the interest of the Supreme Court, which passed a judgment trying to clarify the legislative application of the appointment of the Guardian in the field of advance directives. PMID:24729977

Psychiatric Advance Directives and Social Workers: An Integrative Review

PubMed Central

Van Dorn, Richard A.; Scheyett, Anna; Swanson, Jeffrey W.; Swartz, Marvin S.

2013-01-01

Psychiatric Advance Directives (PADs) are legal documents that allow individuals to express their wishes for future psychiatric care and to authorize a legally appointed proxy to make decisions on their behalf during incapacitating crises. PADs are viewed as an alternative to the coercive interventions that sometimes accompany mental health crises for persons with mental illness. Insofar as coercive interventions can abridge clients’ autonomy and self-determination -- values supported by the Profession’s Code of Ethics -- social workers have a vested interest in finding ways to reduce coercion and increase autonomy and self-determination in their practice. However, PADs are also viewed as having the potential to positively affect a variety of other clinical outcomes, including but not limited to treatment engagement, treatment satisfaction, and working alliance. This article reviews the clinical and legal history of PADs and empirical evidence for their implementation and effectiveness. Despite what should be an inherent interest in PADs, and the fact that laws authorizing PADs have proliferated in the past decade, there is little theoretical or empirical research in the social work literature. PMID:20408357

[Theological moral considerations of advance directives].

PubMed

Virt, G

1997-01-01

The forms for advanced directives vary considerably in respect to content and wording. This article intends to develop ethical criteria for such texts, from the moraltheological point of view, also considering the social context.

Promoting advance directives among African Americans: a faith-based model.

PubMed

Bullock, Karen

2006-02-01

Studies show that African Americans are less likely than other ethnic groups to complete advance directives. However, what influences African Americans' decisions to complete or not complete advance directives is unclear. Using a faith-based promotion model, 102 African Americans aged 55 years or older were recruited from local churches and community-based agencies to participate in a pilot study to promote advance care planning. Focus groups were used to collect data on participants' preferences for care, desire to make personal choices, values and attitudes, beliefs about death and dying, and advance directives. A standardized interview was used in the focus groups, and the data were organized and analyzed using NUDIST 4 software (QRS Software, Victoria, Australia). Three fourths of the participants refused to complete advance directives. The following factors influenced the participants' decisions about end-of-life care and completion of an advance directive: spirituality; view of suffering, death, and dying; social support networks; barriers to utilization; and mistrust of the health care system. The dissemination of information apprises individuals of their right to self-determine about their care, but educational efforts may not produce a significant change in behavior toward completion of advance care planning. Thus, ongoing efforts are needed to improve the trust that African Americans have in medical and health care providers.

Protecting me from my Directive: Ensuring Appropriate Safeguards for Advance Directives in Dementia.

PubMed

Auckland, Cressida

2018-02-01

With one in six people over 80 now suffering from dementia, advance directives provide an important means of empowerment. Upholding directives in the context of dementia, however, raises extra challenges, given the potential for the directive to conflict with an assessment of what is in the person's current best interests. Given the profound harm that tying a person with dementia to their previous wishes can do, it is essential that we have sufficient safeguards in place to ensure that we only uphold such directives where we can be sure they are truly autonomous and are intended to apply to the situation at hand-safeguards which are at present, severely lacking. This article will consider various mechanisms by which safeguards can be built into the legal regime to ensure that the original decision is autonomous, including making it mandatory for the person to undergo a consultation with a healthcare professional, which would involve a contemporaneous capacity assessment. Clinicians must also be confident that the directive applies to the situation at hand. Introducing formalities, including a standardised (though not mandatory) proforma, may help to enhance specificity about when the directive is triggered, and to what treatments it relates, to enable clinicians to better assess the directive's applicability. A national registry for advance directives might also be beneficial. It will be argued that health care professionals will have to play a much greater role in the drafting and registering of advance directives, if we are to feel comfortable in upholding them.

[Expected change of direction in Polish law regarding cosmetics].

PubMed

Karłowski, Kazimierz; Smietanka, Barbara; Biernat, Urszula; Burzyńska, Izabela; Pawłowska, Kamila

2004-01-01

In connection with adaptation of Polish law to UE regulations, new Polish Act on cosmetics was published. There were also prepared regulations concerning: lists the substances forbidden to be used in cosmetics, permitted to be used in cosmetics only with restrictions, allowed colouring agents, preservatives and UV filters, rules of non-inclusion of one or more ingredients on the list used for the labelling, establishing National System for Informing about Cosmetics and methods of analysis necessary for checking the composition of cosmetic products. Publication in Official Journal of the European Union L. 66/26 Directive 2003/15/EC shows direction necessary changes in Polish Act on cosmetics.

Patient safety: honoring advanced directives.

PubMed

Tice, Martha A

2007-02-01

Healthcare providers typically think of patient safety in the context of preventing iatrogenic injury. Prevention of falls and medication or treatment errors is the typical focus of adverse event analyses. If healthcare providers are committed to honoring the wishes of patients, then perhaps failures to honor advanced directives should be viewed as reportable medical errors.

[Advance directives in Italy: a goal not yet reached but already passed?].

PubMed

Riccioni, Luigi; Gristina, Giuseppe

2015-10-01

The advance directives (ADs) have been adopted in many countries to defend patients' autonomy. In Italy, in the past, this topic gave rise to a heated debate involving philosophers, theologians, and politicians. In 2009, the government presented a bill of law on ADs firmly criticized from a scientific, moral and juridical point of view because the bill's content is against the principles of Italian Constitution, Italian Code of Medical Ethics, Oviedo Convention, and official statements of many scientific societies. Although the bill has passed the Low Chamber it lies, even since, in the Senate, lacking in regard any agreement among the political parties. The purpose of this article is to highlight that, in our country, patients, relatives and doctors deserve a law not only related to the specific topic of ADs, but - as in other European countries (Germany, Spain, France, UK) - aimed to deal with the complex issue of end of life care as a whole. This law should take into account the sound evidence existing in regard to the four fundamental principles supporting the best scientific and ethical approaches to the end of life issues: shared decision making process between doctors and patients/relatives; rejection of dying process marked by the suffering; withholding/withdrawing futile treatments together with palliative sedation as two crucial contributions to suppress the patient suffering and pain; clear-cut difference between these clinical/ethical options and euthanasia. At the same time, this law should be able to provide physicians with a legal coverage to make all the clinical and ethical decisions more and more complex because of the continuous evolution of medical science on one hand, and the impressive development of biotechnology on the other hand.

Primary healthcare NZ nurses' experiences of advance directives: understanding their potential role.

PubMed

Davidson, Raewyn; Banister, Elizabeth; de Vries, Kay

2013-07-01

Advance directives are one aspect of advance care planning designed to improve end of life care. The New Zealand Nurses Organisation released their first mission statement in 2010 concerning advance directives suggesting an increase in the use of these. A burgeoning older population, expected to rise over the next few years, places the primary healthcare nurse in a pivotal role to address the challenges in constructing advance directives. While literature supports the role for primary healthcare nurses in promoting advance directives, no research was found on this role in the New Zealand context. This paper presents results of a qualitative study conducted in New Zealand with 13 senior primary healthcare nurses with respect to their knowledge, attitudes, and experiences of advance directives. Results of the analysis revealed a dynamic process involving participants coming to understand their potential role in this area. This process included reflection on personal experience with advance directives; values and ethics related to end of life issues; and professional actions.

Encounters With Health-Care Providers and Advance Directive Completion by Older Adults.

PubMed

Koss, Catheryn

2018-01-01

The Patient Self-Determination Act (PSDA) requires hospitals, home health agencies, nursing homes, and hospice providers to offer new patients information about advance directives. There is little evidence regarding whether encounters with these health-care providers prompt advance directive completion by patients. To examine whether encounters with various types of health-care providers were associated with higher odds of completing advance directives by older patients. Logistic regression using longitudinal data from the 2012 and 2014 waves of the Health and Retirement Study. Participants were 3752 US adults aged 65 and older who reported not possessing advance directives in 2012. Advance directive was defined as a living will and/or durable power of attorney for health care. Four binary variables measured whether participants had spent at least 1 night in a hospital, underwent outpatient surgery, received home health or hospice care, or spent at least one night in a nursing home between 2012 and 2014. Older adults who received hospital, nursing home, or home health/hospice care were more likely to complete advance directives. Outpatient surgery was not associated with advance directive completion. Older adults with no advance directive in 2012 who encountered health-care providers covered by the PSDA were more likely to have advance directives by 2014. The exception was outpatient surgery which is frequently provided in freestanding surgery centers not subject to PSDA mandates. It may be time to consider amending the PSDA to cover freestanding surgery centers.

Opioid needs of patients with advanced cancer and the morphine dose-limiting law in Egypt.

PubMed

Alsirafy, Samy A; El-Mesidi, Salah M; El-Sherief, Wesam A; Galal, Khaled M; Abou-Elela, Enas N; Aklan, Nahla A

2011-01-01

Morphine is the drug of choice for moderate to severe cancer pain management. The Egyptian Narcotics Control Law limits the amount of morphine prescribed in a single prescription to a maximum of 420 mg for tablets and 60 mg for ampoules. The usual practice in Egypt is to provide that limited amount of morphine on a weekly basis. The aim of this study is to estimate the extent to which Egyptian patients may be undertreated because of this law. We reviewed the medical records of advanced cancer patients referred to the first palliative care unit in Egypt over a seven-month period. Cancer pain was managed following the WHO guidelines. After modifying the internal institutional policy, patients received adequate amounts of the available opioids without any violations of the law. From 117 eligible advanced cancer patients, 58 (50%) patients required strong opioids, 32 (27%) required weak opioids, and 27 (23%) required no regular opioids. The mean last prescribed opioid dose for those who required strong opioids was 194 mg of oral morphine equivalent/24 h (± 180). For this group of patients, a single weekly prescription would supply enough oral morphine for only 26% of them. In the case of parenteral morphine, none of these patients would receive an adequate supply. In view of the current morphine dose-limiting law and practices in Egypt, the majority of patients suffering severe cancer pain would not have access to adequate morphine doses. That dose-limiting law and other restrictive regulations represent an obstacle to cancer pain control in Egypt and should be revised urgently.

Is it feasible to discuss an advance directive with a Chinese patient with advanced malignancy? A prospective cohort study.

PubMed

Wong, S Y; Lo, S H; Chan, C H; Chui, H S; Sze, W K; Tung, Y

2012-06-01

Advance directives have been implemented for years in western countries, but the concept is new to Asian cultures. According to traditional Chinese culture, family members usually play a decisive role in a patient's treatment plan. Thus it may be hard to implement an advance directive despite its importance to the treatment of patients. The objectives of this study were to assess the feasibility of advance directive engagement and to explore significant contributing factors to achieving such a goal. Prospective cohort study. Palliative Care Unit of Clinical Oncology, Tuen Mun Hospital, Hong Kong. The subjects of the investigation were adult patients diagnosed to have advanced malignancy and newly referred to the hospice service from 24 April 2009 to 30 July 2009. Data were collected from nursing assessment forms, locally designed advance directive forms, a checklist completed by oncologists, and details available in the electronic hospital record. Of the 191 eligible patients, 120 (63%) had the advance directive, whereas 71 (37%) did not. In the Cox regression model, the patient having insight of a poor prognosis was the most significant factor facilitating advance directive engagement (P=0.001). Any family objection in the discussion of advance directives was also an important factor, though it did not reach statistical significance (P=0.082). Other factors like age, gender, education, religion, financial status, living environment, understanding the diagnosis, bereavement experience, type of cancer, nature of illness, courses of chemotherapy or radiotherapy received, main caregiver, in-house supporter, nurse-led clinic attendance, clinical psychologist consultation, and in-patient hospice nurse coordinator interview were all statistically insignificant. Our study demonstrated that it was feasible to discuss an advance directive with Chinese patients with advanced malignancy. When patients have insight about their poor prognosis and family members have no

Advance directives in psychiatric care: a narrative approach

PubMed Central

Widdershoven, G.; Berghmans, R.

2001-01-01

Advance directives for psychiatric care are the subject of debate in a number of Western societies. By using psychiatric advance directives (or so-called "Ulysses contracts"), it would be possible for mentally ill persons who are competent and with their disease in remission, and who want timely intervention in case of future mental crisis, to give prior authorisation to treatment at a later time when they are incompetent, have become non-compliant, and are refusing care. Thus the devastating consequences of recurrent psychosis could be minimised. Ulysses contracts raise a number of ethical questions. In this article the central issues of concern and debate are discussed from a narrative perspective. Ulysses contracts are viewed as elements of an ongoing narrative in which patient and doctor try to make sense of and get a hold on the recurrent crises inherent in the patient's psychiatric condition. Key Words: Medical ethics • narrative ethics • advance directives • psychiatry PMID:11314165

Advance directives outside the USA: are they the best solution everywhere?

PubMed

Sanchez-Gonzalez, M A

1997-09-01

This article evaluates the potential role of advance directives outside of their original North American context. In order to do this, the article first analyses the historical process which has promoted advance directives in recent years. Next, it brings to light certain presuppositions which have given them force: atomistic individualism, contractualism, consumerism and entrepreneurialism, pluralism, proceduralism, and "American moralism." The article next studies certain European cultural peculiarities which could affect advance directives: the importance of virtue versus rights, stoicism versus consumerist utilitarianism, rationalism verus empiricism, statism versus citizens' initiative, and justice versus autonomy. The article concludes by recognising that autonomy has a transcultural value, although it must be balanced with other principles. Advance Directives can have a function in certain cases. But it does not seem adequate to delegate to advance directives more and more medical decisions, and to make them more binding everyday. It is indispensable to develop other decision-making criteria.

Patients' understanding and use of advance directives.

PubMed Central

Jacobson, J A; White, B E; Battin, M P; Francis, L P; Green, D J; Kasworm, E S

1994-01-01

The Patient Self-Determination Act was implemented in December 1991. Before and after its implementation, we used a structured interview of 302 randomly selected patients to determine their awareness, understanding, and use of advance directives. Implementation of the Act did not have a major effect on these. Although more than 90% of patients were aware of the living will, only about a third selected the correct definition or the correct circumstances in which it applied, and less than 20% of patients had completed one. About a third of patients were aware of a Durable Power of Attorney for Health Care and chose the correct definition, and about half identified the correct circumstances in which it applies; less than 10% had completed such a document. Surprisingly, patients who said they had completed advance directives did not demonstrate better understanding of these documents. Our results indicate that many patients, including some who have completed advance directives, do not fully understand them. It may be unwise to regard these documents as carefully considered, compelling statements of patients' preferences. Appropriate responses to our findings include increased public education, revising state statutes to bring them into congruence with public perception, and expanding the dialogue between physicians and patients. PMID:8191755

Facilitated Psychiatric Advance Directives: A Randomized Trial of an Intervention to Foster Advance Treatment Planning Among Persons with Severe Mental Illness

PubMed Central

Swanson, Jeffrey W.; Swartz, Marvin S.; Elbogen, Eric B.; Van Dorn, Richard A.; Ferron, Joelle; Wagner, H. Ryan; McCauley, Barbara J.; Kim, Mimi

2013-01-01

Objective Studies show a high potential demand for psychiatric advance directives but low completion rates. The authors conducted a randomized study of a structured, manualized intervention to facilitate completion of psychiatric advance directives. Method A total of 469 patients with severe mental illness were randomly assigned to a facilitated psychiatric advance directive session or a control group that received written information about psychiatric advance directives and referral to resources in the public mental health system. Completion of an advance directive, its structure and content, and its short-term effects on working alliance and treatment satisfaction were recorded. Results Sixty-one percent of participants in the facilitated session completed an advance directive or authorized a proxy decision maker, compared with only 3% of control group participants. Psychiatrists rated the advance directives as highly consistent with standards of community practice. Most participants used the advance directive to refuse some medications and to express preferences for admission to specific hospitals and not others, although none used an advance directive to refuse all treatment. At 1-month follow-up, participants in the facilitated session had a greater working alliance with their clinicians and were more likely than those in the control group to report receiving the mental health services they believed they needed. Conclusions The facilitation session is an effective method of helping patients complete psychiatric advance directives and ensuring that the documents contain useful information about patients’ treatment preferences. Achieving the promise of psychiatric advance directives may require system-level policies to embed facilitation of these instruments in usual-care care settings. PMID:17074946

The Role of International Human Rights Norms in the Liberalization of Abortion Laws Globally.

PubMed

Fine, Johanna B; Mayall, Katherine; Sepúlveda, Lilian

2017-06-01

International and regional human rights norms have evolved significantly to recognize that the denial of abortion care in a range of circumstances violates women's and girls' fundamental human rights. These increasingly progressive standards have played a critical role in transforming national-level abortion laws by both influencing domestic high court decisions on abortion and serving as a critical resource in advancing law and policy reform. Courts in countries such as Argentina, Bolivia, Brazil, Colombia, and Nepal have directly incorporated these standards into groundbreaking cases liberalizing abortion laws and increasing women's access to safe abortion services, demonstrating the influence of these human rights standards in advancing women's reproductive freedom. These norms have also underpinned national-level abortion law and policy reform, including in countries such as Spain, Rwanda, Uruguay, and Peru. As these human rights norms further evolve and increasingly recognize abortion as a human rights imperative, these standards have the potential to bolster transformative jurisprudence and law and policy reform advancing women's and girls' full reproductive autonomy.

Variations in Consumer Self-Determination within US Psychiatric Advance Directives

ERIC Educational Resources Information Center

Zeman, Laura Dreuth; Swanke, Jayme

2008-01-01

Advance directives are legal documents that formalize consumer psychiatric care preferences. This article examines the statutes and goals of US psychiatric advance directives within the framework of consumer self-determination, a priority in national mental health reform. It seeks to distinguish between state models based on the degree that…

Difficult end-of-life treatment decisions: do other factors trump advance directives?

PubMed

Hardin, Steven B; Yusufaly, Yasmin A

2004-07-26

Advance directives are widely promoted as a means to plan for patients' decisional incapacity, yet there is little evidence of their effectiveness. We devised a study to assess physicians' compliance with hypothetical advance directives and further examine their clinical reasoning. The study consisted of an analysis of a mailed written survey containing 6 hypothetical cases of seriously ill patients. Each case contained an explicit advance directive with potential conflict between the directive and (1) prognosis, (2) wishes of family or friends, or (3) quality of life. Data were collected on the clinical treatment decisions made by physicians and the reasons for those decisions. Study participants were all internal medicine faculty and resident physicians from a single academic institution. A total of 47% analyzable surveys (117/250) were returned. Decisions by faculty and residents were not consistent with the advance directive in 65% of cases. This inconsistency was similar for faculty and residents (68% and 61%, respectively; P>.05). When physicians made decisions inconsistent with the advance directive, they were more likely to list reasons other than the directive for their decisions (89%; P<.001). Internists frequently made treatment decisions that were not consistent with an explicit advance directive. In difficult clinical situations, internists appear to consider other factors such as prognosis, perceived quality of life, and the wishes of family or friends as more determinative than the directive. Future work needs to explore the generalizability of these findings and examine how strictly patients desire their advance directives to be followed.

[Advance directives in clinical practice : Living will, healthcare power of attorney and care directive].

PubMed

Hack, J; Buecking, B; Lopez, C L; Ruchholtz, S; Kühne, C A

2017-06-01

In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e.g. living will, healthcare power of attorney and care directive) and the possible (legal) applications and limitations in the routine clinical practice.

[Advance directives in clinical practice : Living will, healthcare power of attorney and care directive].

PubMed

Hack, J; Buecking, B; Lopez, C L; Ruchholtz, S; Kühne, C A

2017-02-01

In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e.g. living will, healthcare power of attorney and care directive) and the possible (legal) applications and limitations in the routine clinical practice.

[Advance directives in clinical practice : Living will, healthcare power of attorney and care directive].

PubMed

Hack, J; Buecking, B; Lopez, C L; Ruchholtz, S; Kühne, C A

2017-12-01

In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e.g. living will, healthcare power of attorney and care directive) and the possible (legal) applications and limitations in the routine clinical practice.

[Advance directives in clinical practice : Living will, healthcare power of attorney and care directive].

PubMed

Hack, J; Buecking, B; Lopez, C L; Ruchholtz, S; Kühne, C A

2017-04-01

In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e.g. living will, healthcare power of attorney and care directive) and the possible (legal) applications and limitations in the routine clinical practice.

Death, Taxes and Advance Directives

PubMed Central

D’Amore, J.D.; Jones, S.L.; Sittig, D.F.; Ness, R.B.

2014-01-01

Summary Suboptimal care at the end-of-life can be due to lack of access or knowledge of patient wishes. Ambiguity is often the result of non-standardized formats. Borrowing digital technology from other industries and using existing health information infrastructure can greatly improve the completion, storage, and distribution of advance directives. We believe several simple, low-cost adaptations to regional and federal programs can raise the standard of end-of-life care. PMID:25024771

African Cultural Concept of Death and the Idea of Advance Care Directives

PubMed Central

Ekore, Rabi Ilemona; Lanre-Abass, Bolatito

2016-01-01

An advance care directive is a person's oral or written instructions about his or her future medical care, if he or she becomes unable to communicate. It may be in written or oral form. Africans ordinarily do not encourage the contemplation of death or any discussion about their own or their loved ones’ death. According to the African belief system, life does not end with death, but continues in another realm. Becoming an ancestor after death is a desirable goal of every individual, a feat which cannot be achieved if an individual asks for an unnatural death by attempting to utilize advance care directives. Advance care directives are considered to be too individualistic for communitarian societies such as Africa. Coupled with the communitarian nature of African societies are issues such as lack of awareness of advance directives, fear of death and grief, and the African cultural belief system, which are potential barriers to the utilization of advance care directives in the African setting. Hence, the need for culture sensitivity which makes it imperative that patient's family and loved ones are carried along as far as possible, without compromising the autonomy of the patient in question when utilizing advance care directives. PMID:27803556

African Cultural Concept of Death and the Idea of Advance Care Directives.

PubMed

Ekore, Rabi Ilemona; Lanre-Abass, Bolatito

2016-01-01

An advance care directive is a person's oral or written instructions about his or her future medical care, if he or she becomes unable to communicate. It may be in written or oral form. Africans ordinarily do not encourage the contemplation of death or any discussion about their own or their loved ones' death. According to the African belief system, life does not end with death, but continues in another realm. Becoming an ancestor after death is a desirable goal of every individual, a feat which cannot be achieved if an individual asks for an unnatural death by attempting to utilize advance care directives. Advance care directives are considered to be too individualistic for communitarian societies such as Africa. Coupled with the communitarian nature of African societies are issues such as lack of awareness of advance directives, fear of death and grief, and the African cultural belief system, which are potential barriers to the utilization of advance care directives in the African setting. Hence, the need for culture sensitivity which makes it imperative that patient's family and loved ones are carried along as far as possible, without compromising the autonomy of the patient in question when utilizing advance care directives.

The Role of International Human Rights Norms in the Liberalization of Abortion Laws Globally

PubMed Central

Fine, Johanna B.; Mayall, Katherine; Sepúlveda, Lilian

2017-01-01

Abstract International and regional human rights norms have evolved significantly to recognize that the denial of abortion care in a range of circumstances violates women’s and girls’ fundamental human rights. These increasingly progressive standards have played a critical role in transforming national-level abortion laws by both influencing domestic high court decisions on abortion and serving as a critical resource in advancing law and policy reform. Courts in countries such as Argentina, Bolivia, Brazil, Colombia, and Nepal have directly incorporated these standards into groundbreaking cases liberalizing abortion laws and increasing women’s access to safe abortion services, demonstrating the influence of these human rights standards in advancing women’s reproductive freedom. These norms have also underpinned national-level abortion law and policy reform, including in countries such as Spain, Rwanda, Uruguay, and Peru. As these human rights norms further evolve and increasingly recognize abortion as a human rights imperative, these standards have the potential to bolster transformative jurisprudence and law and policy reform advancing women’s and girls’ full reproductive autonomy. PMID:28630542

Cancellation control law for lateral-directional dynamics of a supermaneuverable aircraft

NASA Technical Reports Server (NTRS)

Snell, Antony

1993-01-01

Cancellation control laws are designed which reduce the high levels of lateral acceleration encountered during aggressive rolling maneuvers executed at high angle of attack. Two independent problem are examined. One is to reduce lateral acceleration at the mass center, while the other focuses on lateral acceleration at the pilot's station, located 7.0 m forward of the mass center. Both of these problems are challenging and somewhat different in their limitations. In each case the design is based on a linearization of the lateral-directional dynamics about a high angle of attack condition. The controllers incorporate dynamic inversion inner loops to provide control of stability-axis roll- and yaw-rates and then employ cancellation filters in both feed-forward and feed-back signal paths. The relative simplicity of the control laws should allow nonlinear generalizations to be devised. Although it is shown that lateral acceleration can be reduced substantially by such control laws, this is at the cost of slowed roll response, poor dutch-roll damping or a combination of the two.

Advance Directives and Powers of Attorney in Intensive Care Patients.

PubMed

de Heer, Geraldine; Saugel, Bernd; Sensen, Barbara; Rübsteck, Charlotte; Pinnschmidt, Hans O; Kluge, Stefan

2017-06-05

Advance directives and powers of attorney are increasingly common, yet data on their use in clinical situations remain sparse. In this single center cross-sectional study, we collected data by questionnaire from 1004 intensive care patients in a university hospital. The frequencies of advance directives and powers of attorney were determined, and the factors affecting them were studied with multivariate logistic regression analysis. Usable data were obtained from 998 patients. 51.3% stated that they had prepared a document of at least one of these two kinds. Among them, 39.6% stated that they had given the relevant document(s) to the hospital, yet such documents were present in the patient's hospital record for only 23%. 508 patients stated their reasons for preparing an advance directive or a power of attorney: the most common reason (48%) was the fear of being at other people's mercy, of the lack of self-determination, or of medical overtreatment. The most important factors associated with a patient's statement that he/she had prepared such a document were advanced age (advance directive: 1.022 [1.009; 1.036], p = 0.001; power of attorney: 1.027 [1.014; 1.040], p<0.001) and elective admission to the hospital (advance directive: 1.622 [1.138; 2.311], p<0.007; power of attorney: 1.459 [1.049; 2.030], p = 0.025). 39.8% of the advance directives and 44.1% of the powers of attorney that were present in the hospital records were poorly interpretable because of the incomplete filling-out of preprinted forms. Half of the patients who did not have such a document had already thought of preparing one, but had not yet done so. For patients hospitalized in intensive care units, there should be early discussion about the presence or absence of documents of these kinds and early evaluation of the patient's concrete wishes in critical situations. Future studies are needed to determine how best to assure that these documents will be correctly prepared and then given over to

Effect of the Contents in Advance Directives on Individuals' Decision-Making.

PubMed

Park, Jae Yoon; Lim, Chi-Yeon; Puurveen, Gloria; Kim, Do Yeun; Lee, Jae Hang; Do, Han Ho; Kim, Kyung Soo; Yoo, Kyung Don; Kim, Hyo Jin; Kim, Yunmi; Shin, Sung Joon

2018-01-01

Completing an advance directive offers individuals the opportunity to make informed choices about end-of-life care. However, these decisions could be influenced in different ways depending on how the information is presented. We randomly presented 185 participants with four distinct types of advance directive: neutrally framed (as reference), negatively framed, religiously framed, and a combination. Participants were asked which interventions they would like to receive at the end of life. Between 60% and 70% of participants responded "accept the special interventions" on the reference form. However, the majority (70%-90%) chose "refuse the interventions" on the negative form. With respect to the religious form, 70% to 80% chose "not decided yet." Participants who refused special life-sustaining treatments were older, female, and with better prior knowledge about advance directives. Our findings imply that the specific content of advance directives could affect decision-making with regard to various interventions for end-of-life care.

[Direct genetic manipulation and criminal code in Venezuela: absolute criminal law void?].

PubMed

Cermeño Zambrano, Fernando G De J

2002-01-01

The judicial regulation of genetic biotechnology applied to the human genome is of big relevance currently in Venezuela due to the drafting of an innovative bioethical law in the country's parliament. This article will highlight the constitutional normative of Venezuela's 1999 Constitution regarding this subject, as it establishes the framework from which this matter will be legally regulated. The approach this article makes towards the genetic biotechnology applied to the human genome is made taking into account the Venezuelan penal law and by highlighting the violent genetic manipulations that have criminal relevance. The genetic biotechnology applied to the human genome has another important relevance as a consequence of the reformulation of the Venezuelan Penal Code discussed by the country's National Assembly. Therefore, a concise study of the country's penal code will be made in this article to better understand what judicial-penal properties have been protected by the Venezuelan penal legislation. This last step will enable us to identify the penal tools Venezuela counts on to face direct genetic manipulations. We will equally indicate the existing punitive loophole and that should be covered by the penal legislator. In conclusion, this essay concerns criminal policy, referred to the direct genetic manipulations on the human genome that haven't been typified in Venezuelan law, thus discovering a genetic biotechnology paradise.

Advance directives: the clinical nurse specialist as a change agent.

PubMed

Meehan, Karen Anne

2009-01-01

The purpose of this article is to describe the impact the clinical nurse specialist (CNS) has on the advance directive process within the cardiac surgery patient population. As a change agent, the CNS needs to be able to increase the number of advance directives obtained and increase the provision of dignified, self-directed, quality patient care. With requirements from The Joint Commission and the Patient Self-determination Act, the change in process must take place to ensure that healthcare professionals are doing all they can do to carry out a patient's wishes. The 6-Source Influencer Model is applied to a case study to illustrate the role of the CNS as a change agent. Following this model, the CNS can facilitate lasting institutional change in the advance directive process. Based on the example, it is possible that a CNS can act as a change agent for other patient populations within the healthcare setting.

Recent developments in health care law: partners in innovation.

PubMed

Berry, Roberta M; Bliss, Lisa; Caley, Sylvia; Lombardo, Paul A; Rooker, Jerri Nims; Todres, Jonathan; Wolf, Leslie E

2010-06-01

This article reviews recent developments in health care law, focusing on the engagement of law as a partner in health care innovation. The article addresses: the history and contents of recent United States federal law restricting the use of genetic information by insurers and employers; the recent federal policy recommending routine HIV testing; the recent revision of federal policy regarding the funding of human embryonic stem cell research; the history, current status, and need for future attention to advance directives; the recent emergence of medical-legal partnerships and their benefits for patients; the obesity epidemic and its implications for the child's right to health under international conventions.

Abandonment and reconciliation: addressing political and common law objections to fetal homicide laws.

PubMed

Curran, Douglas S

2009-03-01

Fetal homicide laws criminalize killing a fetus largely to the same extent as killing any other human being. Historically, the common law did not generally recognize feticide as a crime, but this was because of the evidentiary "born-alive" rule, not because of the substantive understanding of the term "human being." As medicine and science have advanced, states have become increasingly willing to abandon this evidentiary rule and to criminalize feticide as homicide. Although most states have recognized the crime of fetal homicide, fourteen have not. This is largely the result of two independent obstacles: (judicial) adherence to the born-alive rule and (legislative) concern that fetal homicide laws could erode constitutionally protected reproductive rights. This Note explores a variety of fetal homicide laws that states have adopted, demonstrating that popular opinion has shifted toward recognizing this crime. It then directly confronts the objections that have prevented other states from adopting such laws: it first reviews the literature suggesting that the born-alive rule should be abandoned, as it is an obsolete evidentiary standard; it then argues that constitutionally protected reproductive liberties can be reconciled with, and in fact augmented by, punishing the killing of a fetus as a homicide.

Did you seek assistance for writing your advance directive? A qualitative study.

PubMed

Becker, Matthias; Jaspers, Birgit; King, Claudius; Radbruch, Lukas; Voltz, Raymond; Nauck, Friedemann

2010-11-01

the completion of an advanced directive is paired with a high degree of self-responsibility of the signatory. It requires anticipation of probably complex medical situations. In the literature, the family physician is often seen as the most important person for advice when writing an advance directive. But little is known about whether or not patients want to involve medical advisors and to what extent physicians are willing to give advice. The aim of this study was to analyse whether or not individuals approached advisors for the completion of their advance directive, whom they chose and which reasons were given for seeking or foregoing assistance. semi-structured interviews with healthy individuals, chronically ill individuals and patients in palliative care including questions associated with advice for completing an advance directive (8/2008-7/2009). age 55-70 years and advance directive ≥ 3 months old. The interviews were fully transcribed according to standard transcription rules and analysed applying an inductive category development. interviews were conducted with 53 probands (healthy n = 20, chronically ill n = 17, palliative care patients n = 16); 18 probands were male. Mean age was 63.2 ± 4.4 years (range 55-70 years). Professional advice was sought by 12 probands (physician = 2, nurse = 1, lawyer/notary = 8, self-employed advisor = 1), another 8 probands included family members. In 17 cases, the physician knew the proband's advance directive, 36 probands never told their doctor about its existence. Categories of reasons for seeking or foregoing advice were trust/lack of trust, autonomy, rejection and financial considerations. information about the medical implications concerning patient preferences for end-of-life care seems not to be the main focus of interest when individuals write an advance directive. Autonomy and trust into notarially certified documents seem to be more important matters. If family physicians want to have a role in their

Comparison of patients' and health care professionals' attitudes towards advance directives.

PubMed Central

Blondeau, D; Valois, P; Keyserlingk, E W; Hébert, M; Lavoie, M

1998-01-01

OBJECTIVES: This study was designed to identify and compare the attitudes of patients and health care professionals towards advance directives. Advance directives promote recognition of the patient's autonomy, letting the individual exercise a certain measure of control over life-sustaining care and treatment in the eventuality of becoming incompetent. DESIGN: Attitudes to advance directives were evaluated using a 44-item self-reported questionnaire. It yields an overall score as well as five factor scores: autonomy, beneficence, justice, external norms, and the affective dimension. SETTING: Health care institutions in the province of Québec, Canada. Survey sample: The sampling consisted of 921 subjects: 123 patients, 167 physicians, 340 nurses and 291 administrators of health care institutions. RESULTS: Although the general attitude of each population was favourable to the expression of autonomy, multivariate analysis of variance (MANOVA) indicated that physicians attached less importance to this subscale than did other populations (p < .001). Above all, they favoured legal external norms and beneficence. Physicians and administrators also attached less importance to the affective dimension than did patients and nurses. Specifically, physicians' attitudes towards advance directives were shown to be less positive than patients' attitudes. CONCLUSION: More attention should be given to the importance of adequately informing patients about advance directives because they may not represent an adequate means for patients to assert their autonomy. PMID:9800589

Assessment of competence to complete advance directives: validation of a patient centred approach

PubMed Central

Fazel, Seena; Hope, Tony; Jacoby, Robin

1999-01-01

Objective To develop a patient centred approach for the assessment of competence to complete advance directives (“living wills”) of elderly people with cognitive impairment. Design Semistructured interviews. Setting Oxfordshire. Subjects 50 elderly volunteers living in the community, and 50 patients with dementia on first referral from primary care. Main outcome measures Psychometric properties of competence assessment. Results This patient centred approach for assessing competence to complete advance directives can discriminate between elderly persons living in the community and elderly patients with dementia. The procedure has good interrater (r=0.95) and test-retest (r=0.97) reliability. Validity was examined by relating this approach with a global assessment of competence to complete an advance directive made by two of us (both specialising in old age psychiatry). The data were also used to determine the best threshold score for discriminating between those competent and those incompetent to complete an advance directive. Conclusion A patient centred approach to assess competence to complete advance directives can be reliably and validly used in routine clinical practice. Key messagesAdvance directives could potentially be useful for patients with dementia as a means of extending their autonomy when they become incompetentCompetence to complete an advance directive involves understanding possible future clinical situationsVignettes presenting hypothetical medical problems were tested in 100 elderly people, and were found to validly and reliably discriminate between volunteers living in the community and patients with dementiaWe suggest that two clinical vignettes, each followed by a semistructured interview comprising 10 points, can aid in the assessment of competence to complete advance directives PMID:10024254

Sexuality in advanced age in Jewish thought and law.

PubMed

David, Benjamin E; Weitzman, Gideon A

2015-01-01

Judaism has a positive attitude to sexual relations within a marriage, and views such sexual relations as important not only for procreation but also as part of the framework of marriage. This is true for any age group, and sexuality is seen as an essential element of marriage for couples of advanced age. In this article, the authors present the views of Jewish law and thought regarding sexuality among older couples. The authors illustrate this using 3 case studies of couples who sought guidance in the area of sexuality. In addition, this area of counseling benefits greatly from an ongoing relationship and dialogue between expert rabbis in the field and therapists treating older Orthodox Jewish patients for sexual dysfunction. The triad relationship of couple, therapist, and rabbi enhances the ability to treat and assist such couples to seek treatment and overcome their difficulties.

Challenges to implementation of advance directives of will in hospital practice.

PubMed

Cogo, Silvana Bastos; Lunardi, Valéria Lerch; Quintana, Alberto Manuel; Girardon-Perlini, Nara Marilene Oliveira; Silveira, Rosemary Silva da

2016-01-01

to understand the difficulties and limitations in the implementation of advance directives of will in the hospital context. qualitative, exploratory and descriptive study conducted by means of semi-structured interviews with nurses, resident physicians and family caregivers. The data were analyzed by using discursive textual analysis based on the framework of bioethics principles. the following categories emerged: Terminality as an expression of loss and cure as an option for care; concerns about legal implications; advance directives of will demand patient autonomy and proper communication. limitations and difficulties in practice of advance directives of will from the perspective of the participants show, apart from countless conflicts and dilemmas regarding end-of life matters, that impending death experiences obstruct patients' wishes.

The nearest relative in mental health law.

PubMed

Andoh, Benjamin; Gogo, Emmanuel

2004-04-01

This article considers the concept of the 'nearest relative' in mental health law in England and Wales and argues, inter alia, for its retention in a way that avoids violation of the European Convention on Human Rights and the Human Rights Act 1998. It looks, first, at the meaning of nearest relative and then focuses on his/her role today, including its link with advance directives for mental health care, and on the tension between nearest relatives and approved social workers and the law. The problem exposed by JT v. United Kingdom in relation to the Human Rights Act 1998 and its implications for the future are considered. The impact of the Mental Health Bill (2002) on the nearest relative is discussed and recommendations to improve the present law are then suggested.

Too Soon to Give Up? Re-examining the Value of Advance Directives

PubMed Central

Levi, Benjamin H.; Green, Michael J.

2013-01-01

In the face of mounting criticism against advance directives, we describe how a novel, computer-based decision aid addresses some of these important concerns. This decision aid, Making Your Wishes Known: Planning Your Medical Future, translates an individual’s values and goals into a meaningful advance directive that explicitly reflects their healthcare wishes and outlines a plan for how they wish to be treated. It does this by 1) educating users about advance care planning; 2) helping individuals identify, clarify, and prioritize factors that influence their decision-making about future medical conditions; 3) explaining common end-of-life medical conditions and life-sustaining treatment; 4) helping users articulate a coherent set of wishes with regard to advance care planning—in the form of an advance directive readily interpretable by physicians; and 5) helping individuals both choose a spokesperson, and prepare to engage family, friends, and healthcare providers in discussions about advance care planning. PMID:20379910

Space Law and China

NASA Astrophysics Data System (ADS)

Tronchetti, Fabio

2017-08-01

Over the past few years, China has made remarkable achievements in the space sector and become one of the most relevant players in the outer space domain. Highlights of this process have been the deployment in orbit of the first Chinese space station, Tiangong-1, on September 29, 2011; and the landing of the Yutu rover on the lunar surface on December 14, 2013. While technological developments have occurred at such a rapid pace, the same cannot be said of the regulatory framework governing Chinese space activities, which still lays at its infant stage. Indeed, unlike other major space-faring countries, China lacks comprehensive and uniform national space legislation; as of now, China has enacted two low-level administrative regulations addressing the issues of launching and registration of space objects. With the growth of the Chinese space program, such a lack of a structured national space law is beginning to show its limits and to create concerns about its negative impact on business opportunities and the ability of China to fully comply with international obligations. One should keep in mind that the international space treaties (China is part to four international space law treaties) are not self-executing, thus requiring States to adopt domestic measures to ensure their effective implementation. Importantly, Chinese authorities appear to be aware of these issues; as stated by the secretary-general of the Chinese National Space Administration (CNSA) in 2014, national space law has been listed in the national legislation plan and the CNSA is directly engaged in such a process. However, questions remain as to how this drafting process will be conducted and what legal form and content the law will have. For example, China could either decide to proceed with a gradual approach, consisting in the adoption of laws addressing selected issues to be eventually assembled into one single law; or to directly move to the adoption of one comprehensive law. In any case, if

Recent Trends in Advance Directives at Nursing Home Admission and One Year after Admission

ERIC Educational Resources Information Center

McAuley, William J.; Buchanan, Robert J.; Travis, Shirley S.; Wang, Suojin; Kim, MyungSuk

2006-01-01

Purpose: Advance directives are important planning and decision-making tools for individuals in nursing homes. Design and Methods: By using the nursing facility Minimum Data Set, we examined the prevalence of advance directives at admission and 12 months post-admission. Results: The prevalence of having any advance directive at admission declined…

The importance of living wills and advance directives.

PubMed

Alfonso, Heather

2009-10-01

Living wills and advance directives are important components of patients' medical records, which all too often do not indicate the appropriate palliative care measures the patient desires. A review of the current literature indicates that approximately 85% to 95% of the population does not have adequate advance directives or palliative care measures written in their medical record. Furthermore, these orders may not follow the patient when he or she is transferred to other facilities for intermittent care. Unwanted tracheal intubations can be both costly to the facility and distressing to the patient and family members. By instituting a change in policy, organizations can ensure that patients' wishes for end-of-life care are met appropriately. In addition, nurses should advocate for a centralized database at the political level. Copyright 2009, SLACK Incorporated.

Joint crisis plans and psychiatric advance directives in German psychiatric practice.

PubMed

Radenbach, Katrin; Falkai, Peter; Weber-Reich, Traudel; Simon, Alfred

2014-05-01

This study explores the attitude of German psychiatrists in leading positions towards joint crisis plans and psychiatric advance directives. This topic was examined by contacting 473 medical directors of German psychiatric hospitals and departments. They were asked to complete a questionnaire developed by us. That form contained questions about the incidence and acceptance of joint crisis plans and psychiatric advance directives and previous experiences with them. 108 medical directors of psychiatric hospitals and departments responded (response rate: 22.8%). Their answers demonstrate that in their hospitals these documents are rarely used. Among the respondents, joint crisis plans are more accepted than psychiatric advance directives. There is a certain uncertainty when dealing with these instruments. Our main conclusion is that German psychiatry needs an intensified discussion on the use of instruments for patients to constitute procedures for future critical psychiatric events. For this purpose it will be helpful to collect more empirical data. Furthermore, the proposal of joint crisis plans in psychiatric hospitals and departments should be discussed as well as the possibility of consulting an expert during the preparation of a psychiatric advance directive.

Geysers advanced direct contact condenser research

DOE Office of Scientific and Technical Information (OSTI.GOV)

Henderson, J.; Bahning, T.; Bharathan, D.

1997-12-31

The first geothermal application of the Advanced Direct Contact Condenser (ADCC) technology developed by the National Renewable Energy Laboratory (NREL) is now operational and is being tested at The Geysers Power Plant Unit 11. This major research effort is being supported through the combined efforts of NREL, The Department of Energy (DOE), and Pacific Gas and Electric (PG&E). NREL and PG&E have entered into a Cooperative Research And Development Agreement (CRADA) for a project to improve the direct-contact condenser performance at The Geysers Power Plant. This project is the first geothermal adaptation of an advanced condenser design developed for themore » Ocean Thermal Energy Conversion (OTEC) systems. PG&E expects this technology to improve power plant performance and to help extend the life of the steam field by using steam more efficiently. In accordance with the CRADA, no money is transferred between the contracting parties. In this case the Department of Energy is funding NREL for their efforts in this project and PG&E is contributing funds in kind. Successful application of this technology at The Geysers will provide a basis for NREL to continue to develop this technology for other geothermal and fossil power plant systems.« less

Smoke-free laws and direct democracy initiatives on smoking bans in Germany: a systematic review and quantitative assessment.

PubMed

Kohler, Stefan; Minkner, Philipp

2014-01-03

Germany's 16 states regulate smoking differently within health protection principles laid down in the federal law. All state smoke-free laws in Germany have undergone at least one change since taking effect. We systematically review federal and state laws regulating smoking, as well as petitions, popular initiatives and referenda that aimed at changing statutory smoking bans. Data generated through the systematic review were correlated with state smoking rates. The protection from the dangers of secondhand smoke is the primary motive for smoking bans in Germany. The first smoke-free laws affecting smoking in pubs, restaurants and several other public places were introduced in 2007. In 2008, the Federal Constitutional Court of Germany ruled in a leading decision on the smoke-free laws of two states that some common smoking ban exemptions of the introduced smoke-free laws violate the basic right to freely exercise a profession and mandated revisions. All states but Bavaria and Saarland, whose smoking bans were more and less comprehensive than those judged by the constitutional court, respectively, needed to change the smoking ban exemptions to reconcile their smoke-free laws with the constitution. Direct democracy initiatives to change smoking bans were only successful in Bavaria in 2010, but a total of 15 initiatives by citizens' or interest groups attempted to influence non-smokers protection legislation through direct democratic procedures. Early ratification of a smoking ban in a federal state correlates with a higher reduction in the smoking rate from 2005 to 2009 (Spearman's ρ = 0.51, p = 0.04). The federal government structure and direct democratic participation in smoke-free legislation in Germany has produced a diversity of local smoking bans and exemptions.

Advance directives: the consecration of autonomy and dignity of the human being.

PubMed

Chaves, Marianna

2013-12-01

Advance directives emerge in the doctor-patient relationship as a way to ensure that the autonomy of the patient is observed, prior to a potential state of incapacity. Thus, autonomy can be exercised ensuring patient's dignity and self-determination. Advance directives yet have the power to drive the medical practitioner and his staff so that it is given the treatment and care previously chosen by the patient. The main purpose of this paper is to show the lack of legislation on the matter in Brazil versus the recognition of Advance Directives by the Brazilian Federal Council of Medicine. Can a mere resolution of the Council transform directives into enforceable wishes? This is an answer we intend to offer throughout the text.

A Comparison of State Advance Directive Documents

ERIC Educational Resources Information Center

Gunter-Hunt, Gail; Mahoney, Jane E.; Sieger, Carol E.

2002-01-01

Purpose: Advance directive (AD) documents are based on state-specific statutes and vary in terms of content. These differences can create confusion and inconsistencies resulting in a possible failure to honor the health care wishes of people who execute health care documents for one state and receive health care in another state. The purpose of…

Recent Advances in High-Performance Direct Methanol Fuel Cells

NASA Technical Reports Server (NTRS)

Narayanan, S. R.; Chun, W.; Valdez, T. I.; Jeffries-Nakamura, B.; Frank, H.; Surumpudi, S.; Halpert, G.; Kosek, J.; Cropley, C.; La Conti, A. B.;

48 CFR 225.7402-4 - Law of war training.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 3 2014-10-01 2014-10-01 false Law of war training. 225... States 225.7402-4 Law of war training. (a) Basic training. Basic law of war training is required for all...=en-US. (b) Advanced law of war training. (1) The types of personnel that must obtain advanced law of...

48 CFR 225.7402-4 - Law of war training.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Law of war training. 225... States 225.7402-4 Law of war training. (a) Basic training. Basic law of war training is required for all...= en-US. (b) Advanced law of war training. (1) The types of personnel that must obtain advanced law of...

Smoke-Free Laws and Direct Democracy Initiatives on Smoking Bans in Germany: A Systematic Review and Quantitative Assessment

PubMed Central

Kohler, Stefan; Minkner, Philipp

2014-01-01

Background: Germany’s 16 states regulate smoking differently within health protection principles laid down in the federal law. All state smoke-free laws in Germany have undergone at least one change since taking effect. Methods: We systematically review federal and state laws regulating smoking, as well as petitions, popular initiatives and referenda that aimed at changing statutory smoking bans. Data generated through the systematic review were correlated with state smoking rates. Results: The protection from the dangers of secondhand smoke is the primary motive for smoking bans in Germany. The first smoke-free laws affecting smoking in pubs, restaurants and several other public places were introduced in 2007. In 2008, the Federal Constitutional Court of Germany ruled in a leading decision on the smoke-free laws of two states that some common smoking ban exemptions of the introduced smoke-free laws violate the basic right to freely exercise a profession and mandated revisions. All states but Bavaria and Saarland, whose smoking bans were more and less comprehensive than those judged by the constitutional court, respectively, needed to change the smoking ban exemptions to reconcile their smoke-free laws with the constitution. Direct democracy initiatives to change smoking bans were only successful in Bavaria in 2010, but a total of 15 initiatives by citizens’ or interest groups attempted to influence non-smokers protection legislation through direct democratic procedures. Early ratification of a smoking ban in a federal state correlates with a higher reduction in the smoking rate from 2005 to 2009 (Spearman’s ρ = 0.51, p = 0.04). Conclusions: The federal government structure and direct democratic participation in smoke-free legislation in Germany has produced a diversity of local smoking bans and exemptions. PMID:24394216

Canadian advanced life support capacities and future directions

NASA Astrophysics Data System (ADS)

Bamsey, M.; Graham, T.; Stasiak, M.; Berinstain, A.; Scott, A.; Vuk, T. Rondeau; Dixon, M.

2009-07-01

Canada began research on space-relevant biological life support systems in the early 1990s. Since that time Canadian capabilities have grown tremendously, placing Canada among the emerging leaders in biological life support systems. The rapid growth of Canadian expertise has been the result of several factors including a large and technically sophisticated greenhouse sector which successfully operates under challenging climatic conditions, well planned technology transfer strategies between the academic and industrial sectors, and a strong emphasis on international research collaborations. Recent activities such as Canada's contribution of the Higher Plant Compartment of the European Space Agency's MELiSSA Pilot Plant and the remote operation of the Arthur Clarke Mars Greenhouse in the Canadian High Arctic continue to demonstrate Canadian capabilities with direct applicability to advanced life support systems. There is also a significant latent potential within Canadian institutions and organizations with respect to directly applicable advanced life support technologies. These directly applicable research interests include such areas as horticultural management strategies (for candidate crops), growth media, food processing, water management, atmosphere management, energy management, waste management, imaging, environment sensors, thermal control, lighting systems, robotics, command and data handling, communications systems, structures, in-situ resource utilization, space analogues and mission operations. With this background and in collaboration with the Canadian aerospace industry sector, a roadmap for future life support contributions is presented here. This roadmap targets an objective of at least 50% food closure by 2050 (providing greater closure in oxygen, water recycling and carbon dioxide uptake). The Canadian advanced life support community has chosen to focus on lunar surface infrastructure and not low Earth orbit or transit systems (i.e. microgravity

Health Care's Other "Big Deal": Direct Primary Care Regulation in Contemporary American Health Law.

PubMed

Chappell, Glenn E

2017-03-01

Direct primary care is a promising, market-based alternative to the fee-for-service payment structure that shapes doctor–patient relationships in America. Instead of billing patients and insurers service by service, direct primary care doctors charge their patients a periodic, prenegotiated fee in exchange for providing a wide range of healthcare services and increased availability compared to traditional practices. This “subscription” model is intended to eliminate the administrative burdens associated with insurer interaction, which, in theory, allows doctors to spend more time with their patients and less time doing paperwork. Direct practices have become increasingly popular since Congress passed the Affordable Care Act (ACA). This growth has been driven by legislation in several states that resolves a number of legal questions that slowed the model’s growth and by the ACA’s recognition of the model as a permissible way to cover primary care in "approved" health plans. Yet legal scholars have hardly focused on direct primary care. Given the model’s growth, however, the time is ripe for a more focused legal inquiry. This Note begins that inquiry. After tracing the model’s evolution and its core components, this Note substantively examines the laws in states that regulate direct practices and analyzes how those laws address a number of potential policy concerns. It then analyzes direct primary care’s broader role in the contemporary American healthcare marketplace. Based upon that analysis, this Note concludes that direct primary care is a beneficial innovation that harmonizes well with a cooperative-federalism-based healthcare policy model.

The law of distribution of light beam direction fluctuations in telescopes. [normal density functions

NASA Technical Reports Server (NTRS)

Divinskiy, M. L.; Kolchinskiy, I. G.

1974-01-01

The distribution of deviations from mean star trail directions was studied on the basis of 105 star trails. It was found that about 93% of the trails yield a distribution in agreement with the normal law. About 4% of the star trails agree with the Charlier distribution.

42 CFR 422.128 - Information on advance directives.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... (ii) The MA organization's written policies respecting the implementation of those rights, including a... 42 Public Health 3 2010-10-01 2010-10-01 false Information on advance directives. 422.128 Section 422.128 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...

Control definition study for advanced vehicles

NASA Technical Reports Server (NTRS)

Lapins, M.; Martorella, R. P.; Klein, R. W.; Meyer, R. C.; Sturm, M. J.

1983-01-01

The low speed, high angle of attack flight mechanics of an advanced, canard-configured, supersonic tactical aircraft designed with moderate longitudinal relaxed static stability (Static Margin, SM = 16% C sub W at M = 0.4) was investigated. Control laws were developed for the longitudinal axis (""G'' or maneuver and angle of attack command systems) and for the lateral/directional axes. The performance of these control laws was examined in engineering simulation. A canard deflection/rate requirement study was performed as part of the ""G'' command law evaluation at low angles of attack. Simulated coupled maneuvers revealed the need for command limiters in all three aircraft axes to prevent departure from controlled flight. When modified with command/maneuver limiters, the control laws were shown to be adequate to prevent aircraft departure during aggressive air combat maneuvering.

Advance directives and outcomes of surrogate decision making before death.

PubMed

Silveira, Maria J; Kim, Scott Y H; Langa, Kenneth M

2010-04-01

Recent discussions about health care reform have raised questions regarding the value of advance directives. We used data from survey proxies in the Health and Retirement Study involving adults 60 years of age or older who had died between 2000 and 2006 to determine the prevalence of the need for decision making and lost decision-making capacity and to test the association between preferences documented in advance directives and outcomes of surrogate decision making. Of 3746 subjects, 42.5% required decision making, of whom 70.3% lacked decision-making capacity and 67.6% of those subjects, in turn, had advance directives. Subjects who had living wills were more likely to want limited care (92.7%) or comfort care (96.2%) than all care possible (1.9%); 83.2% of subjects who requested limited care and 97.1% of subjects who requested comfort care received care consistent with their preferences. Among the 10 subjects who requested all care possible, only 5 received it; however, subjects who requested all care possible were far more likely to receive aggressive care as compared with those who did not request it (adjusted odds ratio, 22.62; 95% confidence interval [CI], 4.45 to 115.00). Subjects with living wills were less likely to receive all care possible (adjusted odds ratio, 0.33; 95% CI, 0.19 to 0.56) than were subjects without living wills. Subjects who had assigned a durable power of attorney for health care were less likely to die in a hospital (adjusted odds ratio, 0.72; 95% CI, 0.55 to 0.93) or receive all care possible (adjusted odds ratio, 0.54; 95% CI, 0.34 to 0.86) than were subjects who had not assigned a durable power of attorney for health care. Between 2000 and 2006, many elderly Americans needed decision making near the end of life at a time when most lacked the capacity to make decisions. Patients who had prepared advance directives received care that was strongly associated with their preferences. These findings support the continued use of advance

Paramedics experiences and expectations concerning advance directives: a prospective, questionnaire-based, bi-centre study.

PubMed

Taghavi, Mahmoud; Simon, Alfred; Kappus, Stefan; Meyer, Nicole; Lassen, Christoph L; Klier, Tobias; Ruppert, David B; Graf, Bernhard M; Hanekop, Gerd G; Wiese, Christoph H R

2012-10-01

Advance directives and palliative crisis cards are means by which palliative care patients can exert their autonomy in end-of-life decisions. To examine paramedics' attitudes towards advance directives and end-of-life care. Questionnaire-based investigation using a self-administered survey instrument. Paramedics of two cities (Hamburg and Goettingen, Germany) were included. Participants were questioned as to (1) their attitudes about advance directives, (2) their clinical experiences in connection with end-of-life situations (e.g. resuscitation), (3) their suggestions in regard to advance directives, 'Do not attempt resuscitation' orders and palliative crisis cards. Questionnaires were returned by 728 paramedics (response rate: 81%). The majority of paramedics (71%) had dealt with advance directives and end-of-life decisions in emergency situations. Most participants (84%) found that cardiopulmonary resuscitation in end-of-life patients is not useful and 75% stated that they would withhold cardiopulmonary resuscitation in the case of legal possibility. Participants also mentioned that more extensive discussion of legal aspects concerning advance directives should be included in paramedic training curricula. They suggested that palliative crisis cards should be integrated into end-of-life care. Decision making in prehospital end-of-life care is a challenge for all paramedics. The present investigation demonstrates that a dialogue bridging emergency medical and palliative care issues is necessary. The paramedics indicated that improved guidelines on end-of-life decisions and the termination of cardiopulmonary resuscitation in palliative care patients may be essential. Participants do not feel adequately trained in end-of-life care and the content of advance directives. Other recent studies have also demonstrated that there is a need for training curricula in end-of-life care for paramedics.

Impact of advance directives and a health care proxy on doctors' decisions: a randomized trial.

PubMed

Escher, Monica; Perneger, Thomas V; Rudaz, Sandrine; Dayer, Pierre; Perrier, Arnaud

2014-01-01

Advance directives or proxy designations are widely recommended, but how they affect doctors' decision making is not well known. The aim of this study was to quantify the influence of advance directives and proxy opinions on doctors' decisions. We mailed to all the generalists and internists in French-speaking Switzerland (N = 1962) three vignettes describing difficult decisions involving incapacitated patients. In each case, the advance directive requested that further care be withheld. One vignette tested the impact of a written advance directive vs. a proxy. Another compared the impact of a handwritten directive vs. a formalized document. The third vignette compared the impact of a family member vs. a doctor as a proxy. Each vignette was prepared in three or four versions, including a control version in which no directive or proxy was present. Vignettes were randomly allocated to respondents. We used logistic regression to predict the decision to forgo a medical intervention. Compared with the control condition, the odds of forgoing a medical intervention were increased by the written advance directive (odds ratio [OR] 7.3; P < 0.001), the proxy (OR 7.9; P < 0.001), and the combination of the two (OR 35.7; P < 0.001). The handwritten directive had the same impact (OR 13.3) as the formalized directive (OR 13.8). The effect of proxy opinion was slightly stronger when provided by a doctor (OR 11.3) rather than by family (OR 7.8). Advance directives and proxy opinions are equally effective in influencing doctors' decisions, but having both has the strongest effect. The format of the advance directive and the identity of the proxy have little influence on decisions. Copyright © 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Immunotherapy for advanced melanoma: future directions.

PubMed

Valpione, Sara; Campana, Luca G

2016-02-01

As calculated by the meta-analysis of Korn et al., the prognosis of metastatic melanoma in the pretarget and immunological therapy era was poor, with a median survival of 6.2 and a 1-year life expectancy of 25.5%. Nowadays, significant advances in melanoma treatment have been gained, and immunotherapy is one of the promising approaches to get to durable responses and survival improvement. The aim of the present review is to highlight the recent innovations in melanoma immunotherapy and to propose a critical perspective of the future directions of this enthralling oncology subspecialty.

Directional fidelity of nanoscale motors and particles is limited by the 2nd law of thermodynamics—Via a universal equality

NASA Astrophysics Data System (ADS)

Wang, Zhisong; Hou, Ruizheng; Efremov, Artem

2013-07-01

Directional motion of nanoscale motors and driven particles in an isothermal environment costs a finite amount of energy despite zero work as decreed by the 2nd law, but quantifying this general limit remains difficult. Here we derive a universal equality linking directional fidelity of an arbitrary nanoscale object to the least possible energy driving it. The fidelity-energy equality depends on the environmental temperature alone; any lower energy would violate the 2nd law in a thought experiment. Real experimental proof for the equality comes from force-induced motion of biological nanomotors by three independent groups - for translational as well as rotational motion. Interestingly, the natural self-propelled motion of a biological nanomotor (F1-ATPase) known to have nearly 100% energy efficiency evidently pays the 2nd law decreed least energy cost for direction production.

High angle of attack control law development for a free-flight wind tunnel model using direct eigenstructure assignment

NASA Technical Reports Server (NTRS)

Wendel, Thomas R.; Boland, Joseph R.; Hahne, David E.

1991-01-01

Flight-control laws are developed for a wind-tunnel aircraft model flying at a high angle of attack by using a synthesis technique called direct eigenstructure assignment. The method employs flight guidelines and control-power constraints to develop the control laws, and gain schedules and nonlinear feedback compensation provide a framework for considering the nonlinear nature of the attack angle. Linear and nonlinear evaluations show that the control laws are effective, a conclusion that is further confirmed by a scale model used for free-flight testing.

[Euthanasia in advanced dementia: directive is useful].

PubMed

Wijsbek, Henri

2013-01-01

The Dutch Euthanasia Act states that an advance directive can replace an actual request for euthanasia in cases in which a patient has become unable to make autonomous decisions. In Euthanasia and the Severely Demented, I agree with Keizer that the severely demented can suffer unbearably, but contrary to Keizer I do not believe that it is impossible to state in advance the conditions under which one would not wish to go on living any longer. Consequently, euthanasia can be permissible even in patients with late-stage dementia, provided that the other due-care criteria are met. Permissibility by itself, however, will not settle disputes about borderline cases. Due to the erratic course of the disease, the right moment for euthanasia may very well be impossible to determine.

Health literacy: a study of internet-based information on advance directives.

PubMed

Stuart, Peter

2017-11-28

The aim of this study was to evaluate the quality and value of web-based information on advance directives. Internet-based information on advance directives was selected because, if it is inaccurate or difficult to understand, patients risk making decisions about their care that may not be followed in practice. Two validated health information evaluation tools, the Suitability Assessment of Materials and DISCERN, and a focus group were used to assess credibility, user orientation and effectiveness. Only one of the 34 internet-based information items on advance directives reviewed fulfilled the study criteria and 30% of the sites were classed as unreadable. In terms of learning and informing, 79% of the sites were considered unsuitable. Using health literacy tools to evaluate internet-based health information highlights that often it is not at a functional literacy level and neither informs nor empowers users to make independent and valid healthcare decisions. ©2017 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

The impact of the Patient Self-Determination Act's requirement that states describe law concerning patients' rights.

PubMed

Teno, Joan M; Sabatino, Charles; Parisier, Lauren; Rouse, Fenella; Lynn, Joanne

1993-01-01

As of December 1991, the Patient Self-Determination Act (PSDA) mandated that health care institutions which receive funding from Medicare or Medicaid provide written information about persons' rights to participate in medical decision-making and formulate advance directives. The PSDA required each state "...acting through a State agency, association, or other private nonprofit entity develop a written description of the law of the State (whether statutory or as recognized by the courts of the State) concerning advance directives that would be distributed by providers or organizations under the requirements of [the Act]." This mandate allowed each state considerable flexibility in its approach to the process of writing the state description and to its content. In 1990, the American Bar Association's Commission on Legal Problems of the Elderly prepared and distributed the Patient Self Determination Act: State Law Guide to assist each state in preparing its written description of state law. In follow-up to the distribution of this guide, we conducted a telephone survey with a representative from each state (including the District of Columbia) about each state's process for writing the state law description. This paper presents an evaluation of the process used by the states and of the documents they produced.

Revisiting Horton's laws with considerations of the directly drained VS source area

NASA Astrophysics Data System (ADS)

Yang, Soohyun; Paik, Kyungrock

2015-04-01

River networks have been regarded as excellent examples of self-similar patterns in nature. Fractal characteristics of river networks have been quantified through scaling relations between several morphologic variables (e.g., Hack, 1957; Flint, 1974). In particular, Horton's legendary study on scaling properties between numbers and lengths of streams in different orders (Horton, 1945) has significantly influenced research studies in this subject. Today, Horton's laws are referred to the log-linear relationships of three variables across stream orders, i.e., number, length, and area which is later added by Schumm (1956). In a closer look, there is a conceptual inconsistency between their definitions though. While length is defined as the length of stream of a specific order only, area by its definition includes drainage area of lower order streams. To deal with this inconsistency, there was an attempt to distinguish the average area drained directly by the stream of a particular order in the Hortonian formulation (Marani et al., 1991; Beer and Borgas, 1993). Nevertheless, there remains an interesting problem in the definition of directly drained area for 1st order and for the rest orders in these studies. While the whole area of 1st order stream is regarded as the directly drained area in these studies, for a channel to form it needs the minimum drainage area named source area. In this study, we evaluate how significant considering this zero order area separately is in understanding overall river network organization. To this end, we define new expression for the directly drained area and revisit Horton's laws with a generalized formulation. To test the proposed ideas, several river networks extracted from digital elevation models (DEMs) are analyzed. References Beer, T., & Borgas, M. (1993). Horton's laws and the fractal nature of streams. Water Resources Research, 29(5), 1475-1487. Flint, J. J. (1974). Stream gradient as a function of order, magnitude, and

Three laws of robotics and surgery.

PubMed

Moran, Michael

2008-08-01

In 1939, Isaac Asimov solidified the modern science fiction genre of robotics in his short story "Strange Playfellow" but altered our thinking about robots in Runaround in 1942 by formulating the Three Laws. He took an engineer's perspective on advanced robotic technologies. Surgical robots by definition violate the first law, yet his discussions are poignant for our understanding of future potential of robotic urologic surgery. We sought to better understand Asimov's visions by reading his fiction and autobiography. We then sought to place his perceptions of science fact next to the Three Laws (he later added a fourth law, the zeroth). Asimov's Three Laws are often quoted in medical journals during discussions about robotic surgery. His First Law states: "A robot may not injure a human being, or, through inaction, allow a human being to come to harm. " This philosophy would directly conflict with the application in surgery. In fact, most of his robotic stories deal with robots that come into conflicts with the laws. Robots in his cleverly orchestrated works evolve unique solutions to complex hierarchical conflicts with these laws. Asimov anticipated the coming maelstrom of intelligent robotic technologies with prescient unease. Despite his scholarly intuitions, he was able to fathom medical/surgical applications in many of his works. These fictional robotic physicians were able to overcome the first law and aid in the care and management of the sick/injured. Isaac Asimov published over 500 books on topics ranging from Shakespeare to science. Despite his widespread influence, he refused to visit the MIT robotics laboratory to see current, state-of-the-art systems. He managed to lay the foundation of modern robotic control systems with a human-oriented safety mechanism in his laws. "If knowledge can create problems, it is not through ignorance that we can solve them " (I Asimov).

Direct to consumer genetic testing-law and policy concerns in Ireland.

PubMed

de Paor, Aisling

2017-11-25

With rapid scientific and technological advances, the past few years has witnessed the emergence of a new genetic era and a growing understanding of the genetic make-up of human beings. These advances have propelled the introduction of companies offering direct to consumer (DTC) genetic testing, which facilitates the direct provision of such tests to consumers, (for example, via the internet). Although DTC genetic testing offers benefits by enhancing consumer accessibility to such technology, promoting proactive healthcare and increasing genetic awareness, it presents a myriad of challenges, from an ethical, legal and regulatory perspective. As DTC genetic testing usually eliminates the need for a medical professional in accessing genetic tests, this lack of professional guidance and counselling may result in misinterpretation and confusion regarding results. In addition, an evident concern relates to the scientific validity and quality of these tests. A further problem arising is the lack or inadequacy of regulation in this field. Despite the increasing accessibility of DTC genetic testing, this legislative vacuum is apparent in Ireland, where there is no concrete legislation. This article explores the main ethical, legal and regulatory issues arising with the advent of rapid advances in DTC genetic testing in Ireland. Further, with inevitable future advances in genetic science, as well as increasing internet accessibility, the challenges presented are likely to become more amplified. In consideration of the ethical and legal challenges, this paper highlights the regulation of DTC genetic testing as a growing concern in Ireland, recognising its importance to both the scientific community as well as in respect of enhancing consumer confidence in such technologies.

Advance directives lessen the decisional burden of surrogate decision-making for the chronically critically ill.

PubMed

Hickman, Ronald L; Pinto, Melissa D

2014-03-01

To identify the relationships between advance directive status, demographic characteristics and decisional burden (role stress and depressive symptoms) of surrogate decision-makers (SDMs) of patients with chronic critical illness. Although the prevalence of advance directives among Americans has increased, SDMs are ultimately responsible for complex medical decisions of the chronically critically ill patient. Decisional burden has lasting psychological effects on SDMs. There is insufficient evidence on the influence of advance directives on the decisional burden of surrogate decision-makers of patients with chronic critical illness. The study was a secondary data analysis of cross-sectional data. Data were obtained from 489 surrogate decision-makers of chronically critically ill patients at two academic medical centres in Northeast Ohio, United States, between September 2005-May 2008. Data were collected using demographic forms and questionnaires. A single-item measure of role stress and the Center for Epidemiological Studies Depression (CESD) scale were used to capture the SDM's decisional burden. Descriptive statistics, t-tests, chi-square and path analyses were performed. Surrogate decision-makers who were nonwhite, with low socioeconomic status and low education level were less likely to have advance directive documentation for their chronically critically ill patient. The presence of an advance directive mitigates the decisional burden by directly reducing the SDM's role stress and indirectly lessening the severity of depressive symptoms. Most SDMs of chronically critically ill patients will not have the benefit of knowing the patient's preferences for life-sustaining therapies and consequently be at risk of increased decisional burden. Study results are clinically useful for patient education on the influence of advance directives. Patients may be informed that SDMs without advance directives are at risk of increased decisional burden and will require

Older adult opinions of "advance driving directives".

PubMed

Betz, Marian E; Lowenstein, Steven R; Schwartz, Robert

2013-01-01

Discussions about driving cessation are difficult. "Advance driving directives" (ADDs), like advance directives for end-of-life care, would allow drivers to designate someone to help make driving decisions for them in the future. It is not known if older drivers support the concept of ADDs. Cross-sectional study of a convenience sample of English-speaking drivers (55+ years) at 2 independent living facilities and 2 community centers who completed anonymous surveys. Of 168 participants, 80% were female; the median age was 76.5 years (range = 56-93 years). Most (74%) drove daily or almost daily, and 7% reported a crash in the past year. Few had spoken with someone about driving safety (5%) or their wishes when driving skills decline (21%). Of the few who had discussed this topic, 83% had spoken with a family member; only 17% had spoken with a health care provider. However, participants were open to driving discussions, and 54% said they would be willing to complete an ADD if recommended. Of these, 79% said it was "likely" or "very likely" they would comply with the directive in the future. Most (73%) supported mandatory, age-based retesting; the median recommended testing age suggested was 80 years. More participants thought the driver (71%), a family member (61%), or a physician (59%) should determine license revocation for an unsafe driver, rather than the department of motor vehicles (32%). Many older drivers may be open to discussing their driving plans with physicians and family members. ADDs may facilitate these discussions in the present and help define driving-related wishes in the future.

Willingness to complete advance directives among low-income older adults living in the USA.

PubMed

Ko, Eunjeong; Lee, Jaehoon; Hong, Youngjoon

2016-11-01

This study explored low-income older adults' willingness to (i) complete advance directives, legal documents, whereby an individual designates decision-makers in the event that they cannot make their own decisions about end-of-life treatment preferences, and (ii) the role of social support and other predictors that impact their willingness. This study was conducted as part of a larger study exploring behaviours of advance care planning among low-income older adults. Out of a total of 255 participants from the original study, this study included 204 participants who did not complete an advance directive for data analysis. A cross-sectional study using probability random sampling stratified by ethnicity was used. Older adults residing in two supportive housing facilities or who were members of a senior centre in San Diego, California, USA, were interviewed in person between December 2010 and April 2011. Hierarchical logistic regression analysis revealed that the majority of participants (72.1%) were willing to complete advance directives and the factors significantly predicting willingness to complete included self-rated health, attitudes towards advance decision-making and social support. Participants with a poorer health status (OR = 1.43, 95% CI = 1.07-1.90) were more willing to complete advance directives. Conversely, participants with higher positive attitudes (OR = 1.18, 95% CI = 1.00-1.39) and greater social support (OR = 1.07, 95% CI = 1.00-1.15) were also more willing to complete advance directives. The findings suggest the importance of ongoing support from healthcare professionals in end-of-life care planning. Healthcare professionals can be a source of support assisting older adults in planning end-of-life care. Initiating ongoing communication regarding personal value and preference for end-of-life care, providing relevant information and evaluating willingness to complete as well as assisting in the actual completion of advance directives

[Attitudes on euthanasia and medical advance directives].

PubMed

van Oorschot, B; Lipp, V; Tietze, A; Nickel, N; Simon, A

2005-02-11

With regard to medical decisions and measures at the end of life, the values and attitudes of those concerned are crucial. However, they have hardly been taken into account so far in German empirical studies on euthanasia and medical advance directives. Between October 2003 and May 2004, a mail survey of a representative group of internists, anaesthetists and general practitioners from Bavaria, Westphalia-Lippe and Thuringia was conducted. Of 1,557 mailed questionnaires 727 were returned (rate of returns: 46 %). The survey showed, high of appreciation for medical advance directives and, at the same, time scepticism regarding surrogate decision-making by legal guardians and authorized representatives. Furthermore, the survey revealed a considerable amount of uncertainty in the physicians about the application of certain measures at the end of life to the different forms of euthanasia. In practice, many physicians do not comprehend the juridical differentiation between (illegal) active and (legal) passive or indirect euthanasia. In training and further education more scope should be given to the reflection of medical decisions at the end of life. At the same time, the usual, partly counterintuitive legal definitions should be brought more into line with medical decision making, while taking into account developments in English speaking areas. A transdisciplinary discourse is indispensable for the development of medical ethical and legal justifications suitable as guidance for action.

7 CFR 1948.88 - Direct land acquisition by FmHA or its successor agency under Public Law 103-354.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 13 2011-01-01 2009-01-01 true Direct land acquisition by FmHA or its successor... by FmHA or its successor agency under Public Law 103-354. (a) FmHA or its successor agency under... Governor of the State in which the real property is located. FmHA or its successor agency under Public Law...

7 CFR 1948.88 - Direct land acquisition by FmHA or its successor agency under Public Law 103-354.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 13 2010-01-01 2009-01-01 true Direct land acquisition by FmHA or its successor... by FmHA or its successor agency under Public Law 103-354. (a) FmHA or its successor agency under... Governor of the State in which the real property is located. FmHA or its successor agency under Public Law...

Prevalence and predictors of advance directives in Australia.

PubMed

White, B; Tilse, C; Wilson, J; Rosenman, L; Strub, T; Feeney, R; Silvester, W

2014-10-01

Advance care planning is regarded as integral to better patient outcomes, yet little is known about the prevalence of advance directives (AD) in Australia. To determine the prevalence of AD in the Australian population. A national telephone survey about estate and advance planning. Sample was stratified by age (18-45 and >45 years) and quota sampling occurred based on population size in each state and territory. Fourteen per cent of the Australian population has an AD. There is state variation with people from South Australia and Queensland more likely to have an AD than people from other states. Will making and particularly completion of a financial enduring power of attorney are associated with higher rates of AD completion. Standard demographic variables were of limited use in predicting whether a person would have an AD. Despite efforts to improve uptake of advance care planning (including AD), barriers remain. One likely trigger for completing an AD and advance care planning is undertaking a wider future planning process (e.g. making a will or financial enduring power of attorney). This presents opportunities to increase advance care planning, but steps are needed to ensure that planning, which occurs outside the health system, is sufficiently informed and supported by health information so that it is useful in the clinical setting. Variations by state could also suggest that redesign of regulatory frameworks (such as a user-friendly and well-publicised form backed by statute) may help improve uptake of AD. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

A history of ethics and law in the intensive care unit.

PubMed

Luce, John M; White, Douglas B

2009-01-01

Because they provide potential benefit at great personal and public cost, the intensive care unit (ICU) and the interventions rendered therein have become symbols of both the promise and the limitations of medical technology. At the same time, the ICU has served as an arena in which many of the ethical and legal dilemmas created by that technology have been defined and debated. This article outlines major events in the history of ethics and law in the ICU, covering the evolution of ICUs, ethical principles, informed consent and the law, medical decision-making, cardiopulmonary resuscitation, withholding and withdrawing life-sustaining therapy, legal cases involving life support, advance directives, prognostication, and futility and the allocation of medical resources. Advancement of the ethical principle of respect for patient autonomy in ICUs increasingly is in conflict with physicians' concern about their own prerogatives and with the just distribution of medical resources.

A 'Scottish Poor Law of Lunacy'? Poor Law, Lunacy Law and Scotland's parochial asylums.

PubMed

Farquharson, Lauren

2017-03-01

Scotland's parochial asylums are unfamiliar institutional spaces. Representing the concrete manifestation of the collision between two spheres of legislation, the Poor Law and the Lunacy Law, six such asylums were constructed in the latter half of the nineteenth century. These sites expressed the enduring mandate of the Scottish Poor Law 1845 over the domain of 'madness'. They were institutions whose very existence was fashioned at the directive of the local arm of the Poor Law, the parochial board, and they constituted a continuing 'Scottish Poor Law of Lunacy'. Their origins and operation significantly subverted the intentions and objectives of the Lunacy Act 1857, the aim of which had been to institute a public district asylum network with nationwide coverage.

Japanese citizens' attitude toward end-of-life care and advance directives: A qualitative study for members of medical cooperatives.

PubMed

Hirayama, Yoko; Otani, Takashi; Matsushima, Masato

2017-12-01

Japanese citizens are interested in choosing their own end-of-life care, but few have created their own advance directive. This study examined changes among Japanese citizens' attitudes toward end-of-life care and advance directives and explored factors that affected these attitudes. We conducted five focus groups with 48 participants in 2009 and 2010. All participants were members of health cooperatives in Tokyo. We identified many barriers and reasons for creating and writing down advance directives. Experience caring for dying people and having a serious disease affected attitudes toward advance directives. Some participants changed their attitude toward end-of-life care by writing their own advance directive. When someone is writing advance directives, asking about his/her past experience of caring may be helpful. And learning about or filling out advance directives may help to break down resistance to using these documents.

Palliative care and other physicians' knowledge, attitudes and practice relating to the law on withholding/withdrawing life-sustaining treatment: Survey results.

PubMed

Cartwright, Colleen Maria; White, Ben P; Willmott, Lindy; Williams, Gail; Parker, Malcolm Holbrook

2016-02-01

To effectively care for people who are terminally ill, including those without decision-making capacity, palliative care physicians must know and understand the legal standing of Advance Care Planning in their jurisdiction of practice. This includes the use of advance directives/living wills and substitute decision-makers who can legally consent to or refuse treatment if there is no valid advance directive. This study aimed to investigate the knowledge, attitudes and practices of medical specialists most often involved in end-of-life care in relation to the law on withholding/withdrawing life-sustaining treatment from adults without decision-making capacity. A pre-piloted survey was posted to specialists in palliative, emergency, geriatric, renal and respiratory medicine; intensive care; and medical oncology in three Australian States. Surveys were analysed using SPSS 20 and SAS 9.3. The overall response rate was 32% (867/2702) - 52% from palliative care specialists. Palliative care specialists and geriatricians had significantly more positive attitudes towards the law (χ42(2) = 94.352; p < 0.001) and higher levels of knowledge about the withholding/withdrawing life-sustaining treatment law (χ7(2) = 30.033; p < 0.001) than did the other specialists, while still having critical gaps in their knowledge. A high level of knowledge of the law is essential to ensure that patients' wishes and decisions, expressed through Advance Care Planning, are respected to the maximum extent possible within the law, thereby according with the principles and philosophy of palliative care. It is also essential to protect health professionals from legal action resulting from unauthorised provision or cessation of treatment. © The Author(s) 2015.

Nonstandard Advance Directives in Emergency Medicine: What Should We Do?

PubMed

Iserson, Kenneth V

2018-07-01

Critically ill or injured emergency department or prehospital patients who lack decision-making capacity sometimes present with a non-standard advance directive, such as a "Do Not Resuscitate" tattoo or medallion. Emergency clinicians must immediately address the question of whether to withhold treatment based on what may or may not be a valid patient directive. Advance directives have been standardized for a good reason. Emergency department or prehospital healthcare providers must be able to immediately interpret and act on them without needing a legal interpretation. When faced with non-standard directives, physicians can follow them, ignore them, or simply use them as an additional piece of information about the individual's wishes for some situations at one point in his or her life. Absent the patient's input or that of aknowledgeable surrogate, both the patient's initial reasons for their non-standard directive and his or her present wishes concerning resuscitation cannot be independently known. Therefore, healthcare providers must initiate treatment while they buy time, attempt to return the patient to lucidity, and search for probative information regarding their current wishes concerning medical treatment. Without such additional information, the moral weight will always favor initiating treatment, since withholding treatment is often irreversible and any treatment instituted can later be withdrawn. Copyright © 2018 Elsevier Inc. All rights reserved.

End-of-life care in the 21st century: advance directives in universal rights discourse.

PubMed

Besirević, Violeta

2010-03-01

This article explores universal normative bases that could help to shape a workable legal construct that would facilitate a global use of advance directives. Although I believe that advance directives are of universal character, my primary aim in approaching this issue is to remain realistic. I will make three claims. First, I will argue that the principles of autonomy, dignity and informed consent, embodied in the Oviedo Convention and the UNESCO Declaration on Bioethics and Human Rights, could arguably be regarded as universal bases for the global use of advance directives. Second, I will demonstrate that, despite the apparent consensus of ethical authorities in support of their global use, it is unlikely, for the time being, that such consensus could lead to unqualified legal recognition of advance directives, because of different understandings of the nature of the international rules, meanings of autonomy and dignity which are context-specific and culture-specific, and existing imperfections that make advance directives either unworkable or hardly applicable in practice. The third claim suggests that the fact that the concept of the advance directive is not universally shared does not mean that it should not become so, but never as the only option in managing incompetent patients. A way to proceed is to prioritize work on developing higher standards in managing incompetent patients and on progressing towards the realization of universal human rights in the sphere of bioethics, by advocating a universal, legally binding international convention that would outlaw human rights violations in end-of-life decision-making.

[Harmonisation of regulatory requirements for clinical trials on medicinal products for human use in the Directive 2001/20/EC and complementary guidance. Implementation of the 12th Law Amending the German Drug Law].

PubMed

Geisler, I; Hofmann, H-P; Nickel, L

2005-02-01

Directive 2001/20/EC of the European Parliament and the Council of 4 April 2001 aims to harmonise national regulations governing clinical trials of medicinal products for human use in the European Union. This aim is to be achieved by harmonising the legal regulations and administrative provisions in force in the Member States, especially with respect to the requirements for starting and conducting clinical trials, taking into account international ethical and scientific standards (Good Clinical Practice). The goal is to further improve the protection of participants in clinical trials and to promote clinical research within the European Union. In Germany, the necessary transposition into the national Drug Law has taken place in the form of the 12th Law Amending the Drug Law of 30 July 2004 as well as complementary implementation provisions. The amendments to the German Drug Law affect in particular the official authorisation procedure, the involvement of ethics committees as well as the conduct of clinical trials on minors. The Directive's requirements have been transposed into German law while maintaining the high level of protection for the participants in clinical trials which had already existed in German legislation.

Anesthesiologists' familiarity with the ASA and ACS guidelines on Advance Directives in the perioperative setting.

PubMed

Nurok, Michael; Green, Douglas S T; Chisholm, Mary F; Fins, Joseph J; Liguori, Gregory A

2014-05-01

To assess anesthesiologists' familiarity with the American Society of Anesthesiologists (ASA) and American College of Surgeons (ACS) guidelines on Advance Directives in the perioperative setting. Single-center, 4-question anonymous survey. Urban academic medical center. Up to 34 subjects responded to each question. Familiarity with the ASA and ACS guidelines on Advance Directives in the perioperative setting ranged from 45% to 100%. There was inadequate familiarity with components of the ASA and ACS guidelines on advance directives in the perioperative setting. Larger studies are required to assess anesthesiologists' familiarity with national society guidelines that directly affect patient care. Future work should investigate best practices for guideline implementation, and consequences of poor adherence to national guidelines. Copyright © 2014 Elsevier Inc. All rights reserved.

Living Wills in Italy: Ethical and Comparative Law Approaches.

PubMed

Veshi, Denard; Neitzke, Gerald

2015-03-01

In this article, advance directives will be analysed through ethical and comparative law approaches. Their importance, the two different types of advance directives and the so-called three steps hierarchy, will be discussed. Living wills will be treated in detail, considering the criticism they have attracted, as well as their known benefits. A thorough examination of the latest version of Arts. 3 and 4 of Italian Bill No. 2350, as approved by the Italian Senate in March 2009 and then amended by the Chamber of Deputies in July 2011, is included. This bill grants advance directives advisory force, limits their application in time and does not allow the validity of oral declarations. This political decision limits autonomy. Furthermore, there are doubts about the constitutionality of this bill, especially with respect to Arts. 2, 13 and 32 of the Italian Constitution, related to the right of self-determination. Further, this article will include a comparative approach of the legal aspects, with particular attention to the French and German models. To conclude, some ethical principles that the Italian legislator must take into consideration are indicated. In addition, some possible modifications of this Bill are suggested based on the experience of other European legislation.

Extending the surrogacy analogy: applying the advance directive model to biobanks.

PubMed

Solomon, Stephanie; Mongoven, Ann

2015-01-01

Biobank donors and biobank governance face a conceptual challenge akin to clinical patients and their designated surrogate decision-makers, the necessity of making decisions and policies now that must be implemented under future unknown circumstances. We propose that biobanks take advantage of this parallel to learn lessons from the historical trajectory of advance directives and develop models analogous to current 'best practice' advance directives such as Values Histories and TheFive Wishes. We suggest how such models could improve biobanks' engagement both with communities and with individual donors by being more honest about the limits of current disclosure and eliciting information to ensure the protection of donor interests more robustly through time than current 'informed consent' processes in biobanking. © 2014 S. Karger AG, Basel.

Advance directives and life-sustaining treatment: attitudes of Hong Kong Chinese elders with chronic disease.

PubMed

Ting, Fion H; Mok, Esther

2011-04-01

To examine the attitudes of Hong Kong Chinese elders with chronic disease with regard to advance directives and life-sustaining treatment. Cross-sectional questionnaire survey. Medical unit of a regional teaching hospital in Hong Kong. In-patients aged 60 years or above with chronic disease. Demographic profiles and attitudes towards advance directives and life-sustaining treatment. A total of 219 elderly patients completed the questionnaire. Their mean age was 73 (standard deviation, 8) years; 133 (61%) were female. The majority had neither heard about advance directives (81%), nor discussed the issue with others (73%) before participating in this study. After they were informed of the concept of advance directives, about half (49%) said they would consider using it if it is legislated in Hong Kong. The respondents generally supported the withholding or withdrawing of life-sustaining treatment in medically futile situations. In all, 55% of them believed that the patient alone should make the decision on withholding or withdrawing life-sustaining treatment, if competent to do so. If the patient became not competent, 44% believed that the individual's family alone should make such a decision. The fact that most of the respondents had never heard about advance directives or discussed the concept with others points to a lack of knowledge and to the necessity to step up public education about such issues.

Psychiatric Advance Directives in India: What will the future hold?

PubMed

Ratnam, Ashutosh; Rudra, Abhijit; Chatterjee, K; Das, R C

2015-08-01

Psychiatric Advance Directives (PADs) have been incorporated into India's Mental Health Care Bill, 2013. This is the first time any form of Advance Directive stands to receive legal sanction in India. PADs have numerous theoretical and empirically tenable therapeutic and financial advantages. Western experiences have shown high acceptance for the concept among psychiatric patients, and illustrated that most stable patients with severe mental illness retain the capacity to frame PADs consistent with community practice standards. However active psychopathology does impair this capacity, and therein, current subjective assessments of competence performed by Physicians without objective instruments are often inaccurate. Though PADs champion patient autonomy, when applied and studied, they have shown little significant advantage-there is currently not enough data to support evidence-based universal recommendations for PADs. PADs as incorporated into the Mental Health Care Bill model on existing Western statutes, and though many of the strengths of earlier systems have been subsumed, so have several of the shortcomings. The risks, benefits and applicability of PADs in India are complicated by the social re-calibration of patient autonomy, mental-healthcare delivery system weaknesses, and the relatively peripheral role the Psychiatrist is mandated to play in the entire advance directive process. Treating patients within the framework of their pre-stated wishes will be a much more intricate and arduous task than most of modern Psychiatric practice in India, but the difficulties, obstacles and inevitable failures encountered will provide evidence of the delivery system's weaknesses and thereby contribute to its strength. Copyright © 2015 Elsevier B.V. All rights reserved.

Supply-demand balance in outward-directed networks and Kleiber's law

PubMed Central

Painter, Page R

2005-01-01

Background Recent theories have attempted to derive the value of the exponent α in the allometric formula for scaling of basal metabolic rate from the properties of distribution network models for arteries and capillaries. It has recently been stated that a basic theorem relating the sum of nutrient currents to the specific nutrient uptake rate, together with a relationship claimed to be required in order to match nutrient supply to nutrient demand in 3-dimensional outward-directed networks, leads to Kleiber's law (b = 3/4). Methods The validity of the supply-demand matching principle and the assumptions required to prove the basic theorem are assessed. The supply-demand principle is evaluated by examining the supply term and the demand term in outward-directed lattice models of nutrient and water distribution systems and by applying the principle to fractal-like models of mammalian arterial systems. Results Application of the supply-demand principle to bifurcating fractal-like networks that are outward-directed does not predict 3/4-power scaling, and evaluation of water distribution system models shows that the matching principle does not match supply to demand in such systems. Furthermore, proof of the basic theorem is shown to require that the covariance of nutrient uptake and current path length is 0, an assumption unlikely to be true in mammalian arterial systems. Conclusion The supply-demand matching principle does not lead to a satisfactory explanation for the approximately 3/4-power scaling of mammalian basal metabolic rate. PMID:16283939

Supply-demand balance in outward-directed networks and Kleiber's law.

PubMed

Painter, Page R

2005-11-10

Recent theories have attempted to derive the value of the exponent alpha in the allometric formula for scaling of basal metabolic rate from the properties of distribution network models for arteries and capillaries. It has recently been stated that a basic theorem relating the sum of nutrient currents to the specific nutrient uptake rate, together with a relationship claimed to be required in order to match nutrient supply to nutrient demand in 3-dimensional outward-directed networks, leads to Kleiber's law (b = 3/4). The validity of the supply-demand matching principle and the assumptions required to prove the basic theorem are assessed. The supply-demand principle is evaluated by examining the supply term and the demand term in outward-directed lattice models of nutrient and water distribution systems and by applying the principle to fractal-like models of mammalian arterial systems. Application of the supply-demand principle to bifurcating fractal-like networks that are outward-directed does not predict 3/4-power scaling, and evaluation of water distribution system models shows that the matching principle does not match supply to demand in such systems. Furthermore, proof of the basic theorem is shown to require that the covariance of nutrient uptake and current path length is 0, an assumption unlikely to be true in mammalian arterial systems. The supply-demand matching principle does not lead to a satisfactory explanation for the approximately 3/4-power scaling of mammalian basal metabolic rate.

Are advance directives helpful for good end of life decision making: a cross sectional survey of health professionals.

PubMed

Peicius, Eimantas; Blazeviciene, Aurelija; Kaminskas, Raimondas

2017-06-05

This paper joins the debate over changes in the role of health professionals when applying advance directives to manage the decision-making process at the end of life care. Issues in relation to advance directives occur in clinical units in Lithuania; however, it remains one of the few countries in the European Union (EU) where the discussion on advance directives is not included in the health-care policy-making agenda. To encourage the discussion of advance directives, a study was designed to examine health professionals' understanding and preferences related to advance directives. In addition, the study sought to explore the views of health care professionals of the application of Advance Directives (AD) in clinical practice in Lithuania. A cross-sectional survey was conducted by interviewing 478 health professionals based at major health care centers in Kaunas district, Lithuania. The design of the study included the use of a questionnaire developed for this study and validated by a pilot study. The collected data were analyzed using standard descriptive statistical methods. The analysis of knowledge about AD revealed some statistically significant differences when comparing the respondents' profession and gender. The analysis also indicated key emerging themes among respondents including tranquility of mind, the longest possible life expectancy and freedom of choice. Further, the study findings revealed that more than half of the study participants preferred to express their will while alive by using advance directives. The study findings revealed a low level of knowledge on advance directives among health professionals. Most health professionals agreed that AD's improved end-of-life decision making while the majority of physicians appreciated AD as the best tool for sharing responsibilities in clinical practice in Lithuania. More physicians than nurses preferred the presence of advance directives to support their decision making in end-of-life situations.

Technological advances in site-directed spin labeling of proteins.

PubMed

Hubbell, Wayne L; López, Carlos J; Altenbach, Christian; Yang, Zhongyu

2013-10-01

Molecular flexibility over a wide time range is of central importance to the function of many proteins, both soluble and membrane. Revealing the modes of flexibility, their amplitudes, and time scales under physiological conditions is the challenge for spectroscopic methods, one of which is site-directed spin labeling EPR (SDSL-EPR). Here we provide an overview of some recent technological advances in SDSL-EPR related to investigation of structure, structural heterogeneity, and dynamics of proteins. These include new classes of spin labels, advances in measurement of long range distances and distance distributions, methods for identifying backbone and conformational fluctuations, and new strategies for determining the kinetics of protein motion. Copyright © 2013 Elsevier Ltd. All rights reserved.

Advance Directives among Nursing Home Residents with Mild, Moderate, and Advanced Dementia.

PubMed

Tjia, Jennifer; Dharmawardene, Marisa; Givens, Jane L

2018-01-01

To describe prevalence and content of AD documentation among NH residents by dementia stage. The prevalence of advance directives (ADs) among nursing home (NH) residents with mild, moderate, and advanced dementia remains unclear. Population-based, cross-sectional study of all licensed NHs in five U.S. states. Subjects included all long-stay (>90 day) NH residents with dementia, aged ≥65 years, and a Cognitive Performance Scale (CPS) score ≥1 from the 2007 to 2008 Minimum Data Set 2.0 (n = 180,621). Dementia severity was classified as follows: mild (CPS 1-2), moderate (CPS 3-4), and advanced (CPS 5-6). ADs were defined as the presence of a living will, do-not-resuscitate order, do-not-hospitalize order, medication restriction, or feeding restriction). Overall, 59% of residents had any AD and 17% had a living will. Prevalence of any AD increased by dementia severity: mild (51.2%), moderate (58.2%), and advanced (61.5%) (p < 0.001). In adjusted analysis, resident characteristics associated with any AD documentation included older age, female gender, being white, and having more severe dementia. Having a living will was associated with higher education (≥high school graduate vs. some high school or less) and being married. While dementia severity was associated with greater likelihood of having documented any AD, almost 4 in 10 residents with dementia lacked any AD. Effective outreach may focus efforts on subgroups with lower odds of any AD or living wills, including non-white, less educated, and unmarried NH residents. A greater understanding of how such factors impact care planning will help to address barriers to patient-centered care for this population.

Opinions about the new law on end-of-life issues in a sample of french patients receiving palliative care.

PubMed

Boulanger, Augustin; Chabal, Théo; Fichaux, Marie; Destandau, Mireille; La Piana, Jean Marc; Auquier, Pascal; Baumstarck, Karine; Salas, Sébastien

2017-01-21

In February 2nd 2016, the French government enacted the Claeys-Leonetti law that forbade euthanasia and established the right to deep and continuous sedation for end-of-life patients. Moreover, the law also obliges clinicians to abide by any advance directives regarding treatment and investigation, except in cases where they are "obviously inappropriate" in a given medical situation, or in cases of emergency, in order to allow medical staff to take time to assess the patient's situation. Artificial feeding and hydration are considered as treatment. The aim of this report is to investigate individuals receiving palliative care about their opinion about euthanasia, about advance directives, about the right to deep and continuous sedation, and the right to stopping artificial feeding and hydration. The study was an opinion survey conducted among patients treated in two different palliative care institutions: a palliative care unit at the University Hospital (Timone, Marseille, France) and a non-profit association palliative care home ("La Maison", Gardanne, France). Face-to-face interviews were performed by two investigators. The survey included sociodemographics, clinical data, and opinions about euthanasia, deep and continuous sedation, stopping artificial feeding and hydration, and advance directives. Forty patients were interviewed. The mean age was 59.8 years (standard deviation 12). Fifty three percent reported opposition to legalized euthanasia. Eighty three percent were in favour of the right to deep and continuous sedation in patients with refractory pain, 75% when it concerns a patient unable to express their wishes, and 68% when the patient decides to stop vital treatment. Fifty eight percent reported that artificial nutrition and hydration should be considered as care. Fifty eight percent of the patients interviewed would like to see doctors follow the express wishes contained in advance care directives and 53% that advance directives should be subject to

The constructal law and the evolution of design in nature.

PubMed

Bejan, Adrian; Lorente, Sylvie

2011-10-01

The constructal law accounts for the universal phenomenon of generation and evolution of design (configuration, shape, structure, pattern, rhythm). This phenomenon is observed across the board, in animate, inanimate and human systems. The constructal law states the time direction of the evolutionary design phenomenon. It defines the concept of design evolution in physics. Along with the first and second law, the constructal law elevates thermodynamics to a science of systems with configuration. In this article we review the more recent work of our group, with emphasis on the advances made with the constructal law in the natural sciences. Highlighted are the oneness of animate and inanimate designs, the origin of finite-size organs on animals and vehicles, the flow of stresses as the generator of design in solid structures (skeletons, vegetation), the universality and rigidity of hierarchy in all flow systems, and the global design of human flows. Noteworthy is the tapestry of distributed energy systems, which balances nodes of production with networks of distribution on the landscape, and serves as key to energy sustainability and empowerment. At the global level, the constructal law accounts for the geography and design of human movement, wealth and communications. Copyright © 2011 Elsevier B.V. All rights reserved.

Advance Directives and End-of-Life Care among Nursing Home Residents Receiving Maintenance Dialysis

PubMed Central

Montez-Rath, Maria E.; Hall, Yoshio N.; Katz, Ronit; O’Hare, Ann M.

2017-01-01

Background and objectives Little is known about the relation between the content of advance directives and downstream treatment decisions among patients receiving maintenance dialysis. In this study, we determined the prevalence of advance directives specifying treatment limitations and/or surrogate decision-makers in the last year of life and their association with end-of-life care among nursing home residents. Design, setting, participants, & measurements Using national data from 2006 to 2007, we compared the content of advance directives among 30,716 nursing home residents receiving dialysis to 30,825 nursing home residents with other serious illnesses during the year before death. Among patients receiving dialysis, we linked the content of advance directives to Medicare claims to ascertain site of death and treatment intensity in the last month of life. Results In the last year of life, 36% of nursing home residents receiving dialysis had a treatment-limiting directive, 22% had a surrogate decision-maker, and 13% had both in adjusted analyses. These estimates were 13%–27%, 5%–11%, and 6%–13% lower, respectively, than for decedents with other serious illnesses. For patients receiving dialysis who had both a treatment-limiting directive and surrogate decision-maker, the adjusted frequency of hospitalization, intensive care unit admission, intensive procedures, and inpatient death were lower by 13%, 17%, 13%, and 14%, respectively, and hospice use and dialysis discontinuation were 5% and 7% higher compared with patients receiving dialysis lacking both components. Conclusions Among nursing home residents receiving dialysis, treatment-limiting directives and surrogates were associated with fewer intensive interventions and inpatient deaths, but were in place much less often than for nursing home residents with other serious illnesses. PMID:28057703

Alternative Fuels Data Center: State Alternative Fuel and Advanced Vehicle

Science.gov Websites

Laws and Incentives: 2014 Year in Review State Alternative Fuel and Advanced Vehicle Laws and Fuel and Advanced Vehicle Laws and Incentives: 2014 Year in Review on Facebook Tweet about Alternative Fuels Data Center: State Alternative Fuel and Advanced Vehicle Laws and Incentives: 2014 Year in Review

Derivation of the Biot-Savart Law from Ampere's Law Using the Displacement Current

ERIC Educational Resources Information Center

Buschauer, Robert

2013-01-01

The equation describing the magnetic field due to a single, nonrelativistic charged particle moving at constant velocity is often referred to as the "Biot-Savart law for a point charge." Introductory calculus-based physics books usually state this law without proof. Advanced texts often present it either without proof or as a special…

Approximately One In Three US Adults Completes Any Type Of Advance Directive For End-Of-Life Care.

PubMed

Yadav, Kuldeep N; Gabler, Nicole B; Cooney, Elizabeth; Kent, Saida; Kim, Jennifer; Herbst, Nicole; Mante, Adjoa; Halpern, Scott D; Courtright, Katherine R

2017-07-01

Efforts to promote the completion of advance directives implicitly assume that completion rates of these documents, which help ensure care consistent with people's preferences in the event of incapacity, are undesirably low. However, data regarding completion of advance directives in the United States are inconsistent and of variable quality. We systematically reviewed studies published in the period 2011-16 to determine the proportion of US adults with a completed living will, health care power of attorney, or both. Among the 795,909 people in the 150 studies we analyzed, 36.7 percent had completed an advance directive, including 29.3 percent with living wills. These proportions were similar across the years reviewed. Similar proportions of patients with chronic illnesses (38.2 percent) and healthy adults (32.7 percent) had completed advance directives. The findings provide benchmarks for gauging future policies and practices designed to motivate completion of advance directives, particularly among those people most likely to benefit from having these documents on record. Project HOPE—The People-to-People Health Foundation, Inc.

Advance directives in nursing homes: prevalence, validity, significance, and nursing staff adherence.

PubMed

Sommer, Sarah; Marckmann, Georg; Pentzek, Michael; Wegscheider, Karl; Abholz, Heinz-Harald; in der Schmitten, Jürgen

2012-09-01

The German Advance Directives Act of 2009 confirms that advance directives (ADs) are binding. Little is known, however, about their prevalence in nursing homes, their quality, and whether they are honored. In 2007, we carried out a cross-sectional survey in all 11 nursing homes of a German city in the state of North Rhine-Westphalia (total nursing home population, 1089 residents). The ADs were formally analyzed and assessed by 3 raters with respect to 5 clinical decision-making scenarios. The specifications of the ADs were compared with what the nurses reported that they would do in each scenario. 11% of the nursing home residents had a personal AD, and a further 1.4% an AD by proxy. 52% of the 119 ADs that we analyzed contained no documentation of the patient's decision-making capacity and/or voluntariness, and only 3% contained documentation of a medical consultation. Most ADs failed to state what should be done in case the patient acutely became incapable of consenting to treatment (inter-rater agreement [IRA] >83%). For the case of permanent decisional incapacity, many ADs contained ambiguous information (IRA<43%). 23 directives stated that the patient should not have cardiopulmonary resuscitation in case an arrest occurred in the patient's current clinical condition, but the nurses reported a corresponding do-not-resuscitate agreement for only 9 of these 23 patients. In 2007, ADs were rare in these German nursing homes, and most of the existing ones were invalid, of little meaning, and/or disregarded by the nursing staff. There is little reason to believe that the Advance Directives Act of 2009 will bring about any major change in this miserable status quo. Advance care planning, a system-oriented concept still uncommon in Germany, could give new impulses to promote a cultural change in this respect.

Interpreting advance directives: ethical considerations of the interplay between personal and cultural identity.

PubMed

Schicktanz, Silke

2009-06-01

In many industrialized countries ethicists and lawyers favour advance directives as a tool to guarantee patient autonomy in end-of-life-decisions. However, most citizens seem reluctant to adopt the practice; the number of patients who have an advance directive is low across most countries. The article discusses the key argument for seeing such documents as an instrument of self-interpretation and life-planning, which ultimately have to be interpreted by third parties as well. Interpretation by third parties and the process of self-reflection are conceptually linked by a qualitative concept of identity. Identity is conceived here as constructed in a processual dialogue between a personal and a cultural perspective. How the cultural dimension comes into play in understanding the motivation, rejection or content of wished for end-of-life-decisions, is shown by a brief review of empirical and cultural studies. Understanding advance directives as a culturally embedded tool of self-interpretation should help to overcome urgent moral problems in clinical settings: how to interpret such documents, how to deliberate on the content and on the best form.

[Advance directives, a tool to humanize care].

PubMed

Olmari-Ebbing, M; Zumbach, C N; Forest, M I; Rapin, C H

2000-07-01

The relationship between the patient and a medical care giver is complex specially as it implies to the human, juridical and practical points of view. It depends on legal and deontological considerations, but also on professional habits. Today, we are confronted to a fundamental modification of this relationship. Professional guidelines exist, but are rarely applied and rarely taught in universities. However, patients are eager to move from a paternalistic relationship to a true partnership, more harmonious and more respectful of individual values ("value based medicine"). Advance directives give us an opportunity to improve our practices and to provide care consistent with the needs and wishes of each patient.

Default Options In Advance Directives Influence How Patients Set Goals For End-Of-Life Care

PubMed Central

Halpern, Scott D.; Loewenstein, George; Volpp, Kevin G.; Cooney, Elizabeth; Vranas, Kelly; Quill, Caroline M.; Mckenzie, Mary S.; Harhay, Michael O.; Gabler, Nicole B.; Silva, Tatiana; Arnold, Robert; Angus, Derek C.; Bryce, Cindy

2015-01-01

Although decisions regarding end-of-life care are personal and important, they may be influenced by the ways in which options are presented. To test this hypothesis, we randomly assigned 132 seriously ill patients to complete one of three types of advance directives. Two types had end-of-life care options already checked—a default choice—but one of these favored comfort-oriented care, and the other, life-extending care. The third type was a standard advance directive with no options checked. We found that most patients preferred comfort-oriented care, but the defaults influenced those choices. For example, 77 percent of patients in the comfort-oriented group retained that choice, while 43 percent of those in the life-extending group rejected the default choice and selected comfort-oriented care instead. Among the standard advance directive group, 61 percent of patients selected comfort-oriented care. Our findings suggest that patients may not hold deep-seated preferences regarding end-of-life care. The findings provide motivation for future research examining whether using default options in advance directives may improve important outcomes, including patients’ receipt of wanted and unwanted services, resource use, survival, and quality of life. PMID:23381535

Physician attitudes toward advanced directives: a literature review of variables impacting on physicians attitude toward advance directives.

PubMed

Coleman, Albert M E

2013-11-01

To review physician's attitudes as well as the variables that may impact on physicians' attitude toward advance directives (ADs). Literature review of 17 published articles, covering the period 1989 to 2011. Physicians overall have a positive attitude toward patients' AD. However, other factors affect this "general positive attitude." These factors influence the attitude-behavior relationship of physicians, and hence their actual practice in relation to patients' AD. The findings from this review are of importance in explaining the differences in the attitude of physicians toward AD and their compliance. This raises the issue of consideration of other ethical paradigms/theories in the clinical context other than the framework of "principlism-"based autonomy, on which AD leans on. This is important in light of the pluralism of ethical theories.

Do coverage mandates affect direct-to-consumer advertising for pharmaceuticals? Evidence from parity laws.

PubMed

Nathenson, Robert; Richards, Michael R

2018-01-29

Direct-to-consumer advertising (DTCA) for prescription drugs is a relatively unique feature of the US health care system and a source of tens of billions of dollars in annual spending. It has also garnered the attention of researchers and policymakers interested in its implications for firm and consumer behavior. However, few economic studies have explored the DTCA response to public policies, especially those mandating coverage of these products. We use detailed advertising expenditure data to assess if pharmaceutical firms increase their marketing efforts after the implementation of relevant state and federal health insurance laws. We focus on mental health parity statutes and related drug therapies-a potentially ripe setting for inducing stronger consumer demand. We find no clear indication that firms expect greater value from DTCA after these regulatory changes. DTCA appears driven by other considerations (e.g., product debut); however, it remains a possibility that firms respond to these laws through other, unobserved channels (e.g., provider detailing).

Advances and future directions of research on spectral methods

NASA Technical Reports Server (NTRS)

Patera, A. T.

1986-01-01

Recent advances in spectral methods are briefly reviewed and characterized with respect to their convergence and computational complexity. Classical finite element and spectral approaches are then compared, and spectral element (or p-type finite element) approximations are introduced. The method is applied to the full Navier-Stokes equations, and examples are given of the application of the technique to several transitional flows. Future directions of research in the field are outlined.

A direct method for synthesizing low-order optimal feedback control laws with application to flutter suppression

NASA Technical Reports Server (NTRS)

Mukhopadhyay, V.; Newsom, J. R.; Abel, I.

1980-01-01

A direct method of synthesizing a low-order optimal feedback control law for a high order system is presented. A nonlinear programming algorithm is employed to search for the control law design variables that minimize a performance index defined by a weighted sum of mean square steady state responses and control inputs. The controller is shown to be equivalent to a partial state estimator. The method is applied to the problem of active flutter suppression. Numerical results are presented for a 20th order system representing an aeroelastic wind-tunnel wing model. Low-order controllers (fourth and sixth order) are compared with a full order (20th order) optimal controller and found to provide near optimal performance with adequate stability margins.

Advance Directives as Support of Autonomy for Persons with Dementia? A Pilot Study among Persons with Dementia and Their Informal Caregivers.

PubMed

Schmidhuber, Martina; Haeupler, Sandra; Marinova-Schmidt, Velislava; Frewer, Andreas; Kolominsky-Rabas, Peter L

2017-01-01

Advance directives could be an important instrument to support a person's will once he/she is not able to consent anymore - if composed competently. A survey was conducted to identify the level of knowledge concerning possibilities and limits of advance directives. The study was conducted as part of the Bavarian Dementia Survey (BayDem). Data were collected from January 2014 to December 2015 by structured face-to-face interviews. Study participants were persons with dementia and their informal caregivers ( n = 74). In total, 66% reported having written an advance directive. Concerning the participants' knowledge about possibilities and limitations of advance directives, a lack of knowledge was noted about the possibility to revoke an advance directive. Furthermore, 70% of informal caregivers and 56% of persons with dementia were not aware of the possibility to include dementia-specific terms in the advance directive. It is necessary to optimize structures for public information and education concerning the topic of advance directives for persons with dementia.

Critical Opportunities for Public Health Law: A Call for Action

PubMed Central

Wood, Jennifer; Burris, Scott; Wagenaar, Alexander C.; Ibrahim, Jennifer K.; Swanson, Jeffrey W.

2013-01-01

Although legal interventions are responsible for many sentinel public health achievements, law is underutilized as a tool for advancing population health. Our purpose was to identify critical opportunities for public health lawmaking. We articulated key criteria and illustrated their use with 5 examples. These opportunities involve significant health problems that are potentially amenable to change through law and for which an effective legal intervention is available: optimizing graduated driver licensing laws, increasing tax rates on alcoholic beverages, regulating sodium in foods, enacting laws to facilitate reversal of opioid overdoses, and improving mental health interventions in the college setting. We call for a national conversation about critical opportunities for public health law to advance evidence-based policymaking. PMID:24028265

From Advance Euthanasia Directive to Euthanasia: Stable Preference in Older People?

PubMed

Bolt, Eva E; Pasman, H Roeline W; Deeg, Dorly J H; Onwuteaka-Philipsen, Bregje D

2016-08-01

To determine whether older people with advance directive for euthanasia (ADEs) are stable in their advance desire for euthanasia in the last years of life, how frequently older people with an ADE eventually request euthanasia, and what factors determine this. Mortality follow-back study nested in a cohort study. The Netherlands. Proxies of deceased members of a cohort representative of Dutch older people (n = 168) and a cohort of people with advance directives (n = 154). Data from cohort members (possession of ADE) combined with after-death proxy information on cohort members' last 3 months of life. Multiple logistic regression analysis was performed on determinants of a euthanasia request in individuals with an ADE. Response rate was 65%. One hundred forty-two cohort members had an ADE at baseline. Three months before death, 87% remained stable in their desire for euthanasia; 47% eventually requested euthanasia (vs 6% without an ADE), and 16% died after euthanasia. People with an ADE were more likely to request euthanasia if they worried about loss of dignity. The majority of older adults who complete an ADE will have a stable preference over time, but an advance desire for euthanasia does not necessarily result in a euthanasia request. Writing an ADE may reflect a person's need for reassurance that they can request euthanasia in the future. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Relationship of social support and decisional conflict to advance directives attitude in Korean older adults: A community-based cross-sectional study.

PubMed

Lee, JuHee; Jung, Dukyoo; Choi, MoonKi

2016-01-01

The aim of this study was to clarify the relationship between social support, decisional conflict, and attitude towards advance directives, and determine whether decisional conflict mediates the relation between social support and advance directives attitude among older adults in South Korea. In total, 209 community-based older adults (mean age, 74.82 years) participated in this cross-sectional study. Demographic characteristics, self-perceived health status, social support, decisional conflict, and advance directives attitude were investigated via a structured questionnaire. Data analysis was carried out using Pearson's correlation and path analyses. The mean score of advance directives attitude was 48.01 (range, 35-61). Decisional conflict and social support were both significantly related to advance directives attitude (P < 0.001). Additionally, decisional conflict was a mediator between social support and advance directives attitudes. The results confirmed the importance of social support for reducing decisional conflict and encouraging positive attitudes toward advance directives. Future studies are needed to support the development of culturally sensitive educational approaches regarding advance directives for older adults in Korea. © 2015 The Authors. Japan Journal of Nursing Science © 2015 Japan Academy of Nursing Science.

A History of Ethics and Law in the Intensive Care Unit

PubMed Central

Luce, John M.; White, Douglas B.

2009-01-01

Synopsis Because they provide potential benefit at great personal and public cost, the intensive care unit (ICU) and the interventions rendered therein have become symbols of both the promise and the limitations of medical technology. At the same time, the ICU has served as an arena in which many of the ethical and legal dilemmas created by that technology have been defined and debated. In this essay, we outline major events in the history of ethics and law in the ICU. We cover 10 areas: 1) the evolution of ICUs, 2) ethical principles, 3) informed consent and the law, 4) medical decision-making, 5) cardiopulmonary resuscitation, 6) withholding and withdrawing life-sustaining therapy, 7) legal cases involving life support, 8) advance directives, 9) prognostication, and 10) futility and the allocation of medical resources. We emphasize that advancement of the ethical principle of respect for patient autonomy in ICUs increasingly is conflicting with physicians’ concern about their own prerogatives and with the just distribution of medical resources. PMID:19268804

Middle-Aged Independent-Living African Americans' Selections for Advance Directives: A Case Study

ERIC Educational Resources Information Center

McDaniel, Brenda J.

2013-01-01

The purpose of this collective embedded qualitative case study was to examine the perspectives of three middle-aged independent-living African Americans who had participated in the process of advance care planning (ACP) and completed at least two advance directives (ADs), a Durable Power of Attorney for Health Care (DPAHC) and a Living Will (LW).…

Space Security Law

NASA Astrophysics Data System (ADS)

Blount, P. J.

2017-06-01

Since the very beginning of the space age, security has been the critical, overriding concern at the heart of both international and domestic space law regimes. While these regimes certainly encompass broader interests, such as commercial uses of outer space, they are built on a legal foundation that is largely intended to regularize interactions among space actors to ensure security, safety, and sustainability in the space environment. Space security law, as a result, has central goals of both maintaining peace and providing security as a public good for the benefit of humankind. The idea of security is a technical and political construct. The law is a tool that is used to articulate that construct as concept and operationalize it as a value. As such, space security law is a network of law and regulation that governs a wide variety of space activities. There are four broad categories that typify the various manifestations of space security law: international peace and security; national security; human security; and space safety and sustainability. International peace and security, the first category, is directly concerned with the international law and norms that have been adopted to decrease the risk of conflict between states. National security, category two, consists of domestic law that implements, at the national level, the obligations found in the first category as well as law that promotes other national security goals. Human security, the third category, is the loose set of law and policy directed at the use of space for the protection of human populations, such as disaster response and planetary protection. Finally, the fourth category, space safety and security, represents the emerging body of law and policy that seeks to protect the space environment through measures that address space debris and harmful contamination. Obviously, these categories overlap and laws can serve duplicative purposes, but this compartmentalization reveals much about the legal

On the application of subcell resolution to conservation laws with stiff source terms

NASA Technical Reports Server (NTRS)

Chang, Shih-Hung

1989-01-01

LeVeque and Yee recently investigated a one-dimensional scalar conservation law with stiff source terms modeling the reacting flow problems and discovered that for the very stiff case most of the current finite difference methods developed for non-reacting flows would produce wrong solutions when there is a propagating discontinuity. A numerical scheme, essentially nonoscillatory/subcell resolution - characteristic direction (ENO/SRCD), is proposed for solving conservation laws with stiff source terms. This scheme is a modification of Harten's ENO scheme with subcell resolution, ENO/SR. The locations of the discontinuities and the characteristic directions are essential in the design. Strang's time-splitting method is used and time evolutions are done by advancing along the characteristics. Numerical experiment using this scheme shows excellent results on the model problem of LeVeque and Yee. Comparisons of the results of ENO, ENO/SR, and ENO/SRCD are also presented.

Advance Directives as Support of Autonomy for Persons with Dementia? A Pilot Study among Persons with Dementia and Their Informal Caregivers

PubMed Central

Schmidhuber, Martina; Haeupler, Sandra; Marinova-Schmidt, Velislava; Frewer, Andreas; Kolominsky-Rabas, Peter L.

2017-01-01

Background Advance directives could be an important instrument to support a person's will once he/she is not able to consent anymore – if composed competently. A survey was conducted to identify the level of knowledge concerning possibilities and limits of advance directives. Methods The study was conducted as part of the Bavarian Dementia Survey (BayDem). Data were collected from January 2014 to December 2015 by structured face-to-face interviews. Study participants were persons with dementia and their informal caregivers (n = 74). Results In total, 66% reported having written an advance directive. Concerning the participants' knowledge about possibilities and limitations of advance directives, a lack of knowledge was noted about the possibility to revoke an advance directive. Furthermore, 70% of informal caregivers and 56% of persons with dementia were not aware of the possibility to include dementia-specific terms in the advance directive. Conclusion It is necessary to optimize structures for public information and education concerning the topic of advance directives for persons with dementia. PMID:29118785

The moral courage of nursing students who complete advance directives with homeless persons.

PubMed

Nash, Woods; Mixer, Sandra J; McArthur, Polly M; Mendola, Annette

2016-11-01

Homeless persons in the United States have disproportionately high rates of illness, injury, and mortality and tend to believe that the quality of their end-of-life care will be poor. No studies were found as to whether nurses or nursing students require moral courage to help homeless persons or members of any other demographic complete advance directives. We hypothesized that baccalaureate nursing students require moral courage to help homeless persons complete advance directives. Moral courage was defined as a trait of a person or an action that overcomes fears or other challenges to achieve something of great moral worth. The hypothesis was investigated through a qualitative descriptive study. Aside from the pre-selection of a single variable to study (i.e. moral courage), our investigation was a naturalistic inquiry with narrative hues insofar as it attended to specific words and phrases in the data that were associated with that variable. A total of 15 baccalaureate nursing students at a public university in the United States responded to questionnaires that sought to elicit fears and other challenges that they both expected to experience and actually experienced while helping homeless persons complete advance directives at a local, non-profit service agency. The study was approved by the Internal Review Board of the authors' university, and each participant signed an informed consent form, which stated that the study involved no reasonably foreseeable risks and that participation was voluntary. Before meeting with homeless persons, participants reported that they expected to experience two fears and a challenge: fear of behaving in ways that a homeless person would deem inappropriate, fear of discussing a homeless person's dying and death, and the challenge of adequately conveying the advance directive's meaning and accurately recording a homeless person's end-of-life wishes. In contrast, after their meetings with homeless persons, relatively few participants

Health Care Professionals' Death Attitudes, Experiences, and Advance Directive Communication Behavior

ERIC Educational Resources Information Center

Black, Kathy

2007-01-01

The study surveyed 135 health care professionals (74 nurses, 32 physicians, and 29 social workers) to examine their personal death attitudes and experiences in relation to their reported advance directive communication practice behavior. Negative correlations were found between collaborating with other health care professionals regarding the…

Differences in presenting advance directives in the chart, in the minimum data set, and through the staff's perceptions.

PubMed

Cohen-Mansfield, Jiska; Libin, Alexander; Lipson, Steven

2003-06-01

Decisions concerning end-of-life care depend on information contained in advance directives that are documented in residents' charts in the nursing home. The availability of that information depends on the quality of the chart and on the location of the information in the chart. No research was found that compared directives by the manner in which they are collected and summarized in the chart. The goal of the proposed study was to clarify how advance directives are summarized in the patient's record and to clarify how physicians perceive the same advance directives and formal orders. The study involved 122 elderly persons who reside in one large (587 beds) nursing home. The authors collected data regarding the advance directives from three sources-Minimum Data Set (MDS), the front cover of the resident's chart, and from inside the chart. The rates of documented advance directives found in this study are higher than those reported in the literature. Agreement rates between sources varied as a function of which sources were compared, as well as on the basis of which directive was examined. More specifically, the authors found higher rates of agreement between the information inside the chart and on the cover of the chart than between the MDS and the other two sources. The reasons for discrepancies may lie in the different functions and procedures pertaining to these source documents.

A multimedia intervention on cardiopulmonary resuscitation and advance directives.

PubMed

Yamada, R; Galecki, A T; Goold, S D; Hogikyan, R V

1999-09-01

To assess the effects of a multimedia educational intervention about advance directives (ADs) and cardiopulmonary resuscitation (CPR) on the knowledge, attitude and activity toward ADs and life-sustaining treatments of elderly veterans. Prospective randomized controlled, single blind study of educational interventions. General medicine clinic of a university-affiliated Veterans Affairs Medical Center (VAMC). One hundred seventeen Veterans, 70 years of age or older, deemed able to make medical care decisions. The control group (n = 55) received a handout about ADs in use at the VAMC. The experimental group (n = 62) received the same handout, with an additional handout describing procedural aspects and outcomes of CPR, and they watched a videotape about ADs. Patients' attitudes and actions toward ADs, CPR and life-sustaining treatments were recorded before the intervention, after it, and 2 to 4 weeks after the intervention through self-administered questionnaires. Only 27.8% of subjects stated that they knew what an AD is in the preintervention questionnaire. This proportion improved in both the experimental and control (87.2% experimental, 52.5% control) subject groups, but stated knowledge of what an AD is was higher in the experimental group (odds ratio = 6.18, p <.001) and this effect, although diminished, persisted in the follow-up questionnaire (OR = 3.92, p =. 003). Prior to any intervention, 15% of subjects correctly estimated the likelihood of survival after CPR. This improved after the intervention in the experimental group (OR = 4.27, p =.004), but did not persist at follow-up. In the postintervention questionnaire, few subjects in either group stated that they discussed CPR or ADs with their physician on that day (OR = 0.97, p = NS). We developed a convenient means of educating elderly male patients regarding CPR and advance directives that improved short-term knowledge but did not stimulate advance care planning.

Advance care planning in 21st century Australia: a systematic review and appraisal of online advance care directive templates against national framework criteria.

PubMed

Luckett, Tim; Bhattarai, Priyanka; Phillips, Jane; Agar, Meera; Currow, David; Krastev, Yordanka; Davidson, Patricia M

2015-11-01

A drive to promote advance care planning at a population level has led to a proliferation of online advance care directive (ACD) templates but little information to guide consumer choice. The current study aimed to appraise the quality of online ACD templates promoted for use in Australia. A systematic review of online Australian ACD templates was conducted in February 2014. ACD templates were identified via Google searches, and quality was independently appraised by two reviewers against criteria from the 2011 report A National Frameworkfor Advance Care Directives. Bias either towards or against future medical treatment was assessed using criteria designed to limit subjectivity. Fourteen online ACD templates were included, all of which were available only in English. Templates developed by Southern Cross University best met the framework criteria. One ACD template was found to be biased against medical treatment--the Dying with Dignity Victoria Advance Healthcare Directive. More research is needed to understand how online resources can optimally elicit and record consumers' individual preferences for future care. Future iterations of the framework should address online availability and provide a simple rating system to inform choice and drive quality improvement.

Hart-Devlin revisited: law, morality and consent in parenthood.

PubMed

Moss, Kate; Hughes, Rowland

2011-04-01

The debate about law and morality is not new but changing social structures and advances in science, medicine and technology have impacted the decisions courts have to make. Within the fast-changing societies of the 21st century, is judicial decision-making cognisant of these advances and how do the judiciary currently reconcile difficult emergent issues concerning law, science and morality? The dilemma of decision-making regarding frozen embryos, the gametes of deceased donors and the issue of consent is analysed by reference to recent case law and the problem of decision-making in relation to the newly possible.

Elder law and Alzheimer's disease.

PubMed

Overman, W H; McCormick, W A

1998-04-27

The elder-law practice focuses on the particular needs of older individuals and their families. Thus, elder law is truly "family" law because the needs of older clients are inextricably interwoven with the needs of their families. This is particularly true for the client who is chronically ill or has some form of dementia, such as Alzheimer's disease. Elder-law attorneys may now be certified to identify to the public those lawyers who demonstrate enhanced knowledge, skills, experience, and proficiency in elder law. Elder law draws from many substantive areas, such as trust, real property, agency, health care, tax, guardianship, will and probate, Social Security, Medicare, and Medicaid law. Together, the client and family are educated on legal options and are assisted in making decisions, formalized through legal documentation. The emphasis is on advance planning. Among legal practitioners, elder-law attorneys understand most clearly that the client's needs must be understood in the context of cultural and family dynamics, and addressed through a team approach involving other professions.

Advance directives and mortality rates among nursing home residents in Taiwan: A retrospective, longitudinal study.

PubMed

Tsai, Hsiu-Hsin; Tsai, Yun-Fang; Liu, Chia-Yih

2017-03-01

No data-based evidence is available regarding the best time for nursing home nurses to obtain residents' signatures on advance directives, especially for do-not-resuscitate directives, the most common type of advance directive. This information is needed to enhance the low prevalence of advance directives in Asian countries. The purposes of this study were to understand (1) the timing between nursing home admission and signing a do-not-resuscitate directive, (2) the factors related to having a do-not-resuscitate directive, and (3) the association between having a do-not-resuscitate directive and nursing home residents' mortality in Taiwan. Retrospective, longitudinal design. Six nursing homes in Taiwan. Nursing home residents (N=563). Data were collected by retrospective chart review with 1-year follow-up. Factors related to having a do-not-resuscitate directive were analyzed by multiple logistic regression, while associations between signing a do-not-resuscitate directive (resuscitation preference) and mortality were examined by Cox proportional hazard regression models. The mean interval between nursing home admission and signing a do-not-resuscitate directive was 840.65days (2.30 years), which was longer than the time from admission to first transfer to hospital (742.4days). Having a do-not-resuscitate directive was related to whether the resident had a nasogastric tube (odds=2.57) and the number of transfers to hospital (odds=1.18). Among the 563 residents, 55 (9.77%) had died at the 1-year follow-up. Having a do-not-resuscitate directive was associated with a greater risk of death (unadjusted hazard ratio, 2.03; 95% confidence interval, 1.10-3.98; p=0.02), but this risk did not persist after adjusting for age (hazard ratio, 1.89; 95% confidence interval, 0.99-3.59; p=0.05). Early research recommendations to sign an advance directive, particularly a do-not-resuscitate order, on nursing home admission may not be the best time for Chinese nursing home residents

Teaching Commercial Law in the Third Year: A Short Report on a Business Organizations and Commercial Law Clinic.

ERIC Educational Resources Information Center

Dolan, John F.; McNair, Russell A., Jr.

1995-01-01

The development and implementation of a clinic to offer advanced study in business organizations and commercial law transactions for third-year law students at Wayne State University (Michigan) are described. The course builds vertically on prior study and puts students in contact with practicing lawyers in an academic setting. Considerations…

Advance directives in patients with advanced cancer receiving active treatment: attitudes, prevalence, and barriers.

PubMed

McDonald, Julie C; du Manoir, Jeanne M; Kevork, Nanor; Le, Lisa W; Zimmermann, Camilla

2017-02-01

The purposes of the study were to assess awareness and prevalence of advance directives (ADs) among patients with advanced cancer undergoing active outpatient care and to determine factors associated with AD completion before and after the diagnosis of cancer. Patients with advanced solid tumor malignancy receiving treatment at the Chemotherapy Day Unit were approached for recruitment. They completed an onsite questionnaire about completion and timing of ADs, demographic information, and perceived health; a review of their medical records was conducted to document their cancer care and co-morbidities. Multinomial logistic regression analysis identified factors associated with the timing of AD completion (pre-cancer, post-cancer, or not at all). Two hundred patients were enrolled, with 193 surveys available for analysis. ADs were completed in 55 % (106/193) of patients, including a living will in 33 % (63/193), a power of attorney in 49 % (95/193), and a do-not-resuscitate (DNR) designation in 18 % (35/193). Most patients (53 %) had completed an AD before being diagnosed with cancer. Higher income (p = 0.02) and age (p = 0.004) were associated with AD completion pre-cancer diagnosis; discussion of end-of-life care (p = 0.02) and palliative care referral (p < 0.0001) were associated with AD completion post-cancer diagnosis. This study demonstrates that different factors may influence the completion of ADs before and after a diagnosis of cancer and highlights the potential for early palliative care to impact the completion of ADs in patients with advanced cancer who are undergoing active cancer treatment.

Derivation of the Biot-Savart Law from Ampere's Law Using the Displacement Current

NASA Astrophysics Data System (ADS)

Buschauer, Robert

2013-12-01

The equation describing the magnetic field due to a single, nonrelativistic charged particle moving at constant velocity is often referred to as the "Biot-Savart law for a point charge." Introductory calculus-based physics books usually state this law without proof.2 Advanced texts often present it either without proof or as a special case of a complicated mathematical formalism.3 Either way, little or no physical insight is provided to the student regarding the underlying physics. This paper presents a novel, basic, and transparent derivation of the Biot-Savart law for a point charge based only on Maxwell's displacement current term in Ampere's law. This derivation can serve many pedagogical purposes. For example, it can be used as lecture material at any academic level to obtain the Biot-Savart law for a point charge from simple principles. It can also serve as a practical example of the important fact that a changing electric flux produces a magnetic field.

Thoughts on Amending China's "Vocational Education Law"

ERIC Educational Resources Information Center

Liu, Yufeng

2014-01-01

An analysis of China's existing "Vocational Education Law" finds that it does not focus entirely on human development or career advancement, nor does it fully reflect the special requirements of vocational education. It does not align the obligations, rights, and liabilities of vocational education stakeholders. The law does not specify…

Power Law Versus Exponential Form of Slow Crack Growth of Advanced Structural Ceramics: Dynamic Fatigue

NASA Technical Reports Server (NTRS)

Choi, Sung R.; Gyekenyesi, John P.

2002-01-01

The life prediction analysis based on an exponential crack velocity formulation was examined using a variety of experimental data on glass and advanced structural ceramics in constant stress-rate ("dynamic fatigue") and preload testing at ambient and elevated temperatures. The data fit to the strength versus In (stress rate) relation was found to be very reasonable for most of the materials. It was also found that preloading technique was equally applicable for the case of slow crack growth (SCG) parameter n > 30. The major limitation in the exponential crack velocity formulation, however, was that an inert strength of a material must be known priori to evaluate the important SCG parameter n, a significant drawback as compared to the conventional power-law crack velocity formulation.

"It's like playing with your destiny": Bosnian immigrants' views of advance directives and end-of-life decision-making.

PubMed

Searight, H Russell; Gafford, Jennifer

2005-07-01

Patient autonomy is a primary value in US health care. It is assumed that patients want to be fully and directly informed about serious health conditions and want to engage in advance planning about medical care at the end-of-life. Written advance directives and proxy decision-makers are vehicles to promote autonomy when patients are no longer able to represent their wishes. Cross-cultural studies have raised questions about the universal acceptance of these health care values among all ethnicities. In the current investigation, Bosnian immigrants were interviewed about their views of physician-patient communication, advance directives, and locus of decision-making in serious illness. Many of the respondents indicated that they did not want to be directly informed of a serious illness. There was an expressed preference for physician- or family-based health care decisions. Advance directives and formally appointed proxies were typically seen as unnecessary and inconsistent with many respondents' personal values. The findings suggest that the value of individual autonomy and control over the health care decisions may not be applicable to cultures with a collectivist orientation.

Dietary biomarkers: advances, limitations and future directions

PubMed Central

2012-01-01

The subjective nature of self-reported dietary intake assessment methods presents numerous challenges to obtaining accurate dietary intake and nutritional status. This limitation can be overcome by the use of dietary biomarkers, which are able to objectively assess dietary consumption (or exposure) without the bias of self-reported dietary intake errors. The need for dietary biomarkers was addressed by the Institute of Medicine, who recognized the lack of nutritional biomarkers as a knowledge gap requiring future research. The purpose of this article is to review existing literature on currently available dietary biomarkers, including novel biomarkers of specific foods and dietary components, and assess the validity, reliability and sensitivity of the markers. This review revealed several biomarkers in need of additional validation research; research is also needed to produce sensitive, specific, cost-effective and noninvasive dietary biomarkers. The emerging field of metabolomics may help to advance the development of food/nutrient biomarkers, yet advances in food metabolome databases are needed. The availability of biomarkers that estimate intake of specific foods and dietary components could greatly enhance nutritional research targeting compliance to national recommendations as well as direct associations with disease outcomes. More research is necessary to refine existing biomarkers by accounting for confounding factors, to establish new indicators of specific food intake, and to develop techniques that are cost-effective, noninvasive, rapid and accurate measures of nutritional status. PMID:23237668

Prevalence of advanced adenomas in small and diminutive colon polyps using direct measurement of size.

PubMed

Tsai, Franklin C; Strum, Williamson B

2011-08-01

Most studies reporting polyp size use visual estimates. Determining the prevalence of advanced histology based on direct measurement of polyp size may help guide the management of polyps found at optical colonoscopy (OC) and CT colonography (CTC). We designed a large, prospective study to assess the prevalence of advanced adenomas based on direct measurement of polyp size by a certified pathologists' assistant as reported in the pathology report. Patients between 40 and 89 years of age who presented for screening colonoscopy were included in our study. Advanced adenomas were defined as ≥10 mm or ≥25% villous features, high grade dysplasia or cancer. Polyps were divided by size into three groups: diminutive (≤5 mm), small (6-9 mm) and large (≥10 mm). If more than one adenoma was present, the most advanced was used for analysis. We evaluated 6,905 consecutive patients referred for colonoscopy between January 2005 and December 2006. Of the 4,967 who met the inclusion criteria, the mean age was 58.8 and consisted of 59% women. Overall, 930 (18.7%) had an adenoma; 248 (5%) were advanced adenomas including 8 (0.16%) cancers. Of 89 polyps≥10 mm, 76 (85%) had advanced histology; of 247 polyps 6-9 mm, 67 (27%) were advanced; of 1,025 polyps ≤5 mm, 105 (10%) were advanced. Thus, 172 of 248 (69%) patients with advanced adenomas had small or diminutive adenomas. Our data indicate the majority (69%) of advanced adenomas are <10 mm. Even among polyps≤5 mm, there was an appreciable prevalence of advanced adenomas (10%). These findings may help guide the management of sub-centimeter colon polyps found by OC or CTC.

Medical experiments on persons with special needs, a comparative study of Islamic jurisprudence vs. Arab laws: UAE law as case study.

PubMed

Hammad, Hamza Abed Al-Karim

2014-01-01

This article is a comparative study of medical experiments on persons with special needs in Islamic jurisprudence and Arab laws; United Arab Emirates (UAE) law as case study. The current study adopts a comparative analytical and descriptive approach. The conclusion of this study points out that the Convention on the Rights of Persons with Special Needs, ratified by a number of Arab States, including the United Arab Emirates, approves conducting medical experiments on persons with special needs, subject to their free consent. As a result of ratifying this Convention, a number of special laws were enacted to be enforced in the United Arab Emirates. On the other hand, this issue is controversial from an Islamic jurisprudence point of view. One group of jurisprudents permits conducting these experimentations if they are designed to treat the person involved, and prohibits such experimentations for scientific advancement. Other jurisprudents permit conducting medical experimentations on persons with special needs, whether the purpose of such experimentations is treatment of the disabled or achieving scientific advancement. The opinion of this group is consistent with the International Convention and the Arab laws in this respect. However, neither the Convention nor the Arab laws regulate this matter by specific and comprehensive conditions, as addressed by some contemporary scholars. It is recommended that the Convention and the Arab laws adopt these conditions. Additionally, the Convention does not state whether the experimentations may be conducted for the interest of the person with disability or for the purpose of scientific advancement. The text of the Convention is unclear and therefore requires further illumination.

Office of River Protection Advanced Low-Activity Waste Glass Research and Development Plan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Peeler, David K.; Kim, Dong-Sang; Vienna, John D.

2015-11-01

The U.S. Department of Energy Office of River Protection (ORP) has initiated and leads an integrated Advanced Waste Glass (AWG) program to increase the loading of Hanford tank wastes in glass while meeting melter lifetime expectancies and process, regulatory, and product performance requirements. The integrated ORP program is focused on providing a technical, science-based foundation for making key decisions regarding the successful operation of the Hanford Tank Waste Treatment and Immobilization Plant (WTP) facilities in the context of an optimized River Protection Project (RPP) flowsheet. The fundamental data stemming from this program will support development of advanced glass formulations, keymore » product performance and process control models, and tactical processing strategies to ensure safe and successful operations for both the low-activity waste (LAW) and high-level waste vitrification facilities. These activities will be conducted with the objective of improving the overall RPP mission by enhancing flexibility and reducing cost and schedule. The purpose of this advanced LAW glass research and development plan is to identify the near-term, mid-term, and longer-term research and development activities required to develop and validate advanced LAW glasses, property-composition models and their uncertainties, and an advanced glass algorithm to support WTP facility operations, including both Direct Feed LAW and full pretreatment flowsheets. Data are needed to develop, validate, and implement 1) new glass property-composition models and 2) a new glass formulation algorithm. Hence, this plan integrates specific studies associated with increasing the Na2O and SO3/halide concentrations in glass, because these components will ultimately dictate waste loadings for LAW vitrification. Of equal importance is the development of an efficient and economic strategy for 99Tc management. Specific and detailed studies are being implemented to understand the fate of Tc

A Control Model: Interpretation of Fitts' Law

NASA Technical Reports Server (NTRS)

Connelly, E. M.

1984-01-01

The analytical results for several models are given: a first order model where it is assumed that the hand velocity can be directly controlled, and a second order model where it is assumed that the hand acceleration can be directly controlled. Two different types of control-laws are investigated. One is linear function of the hand error and error rate; the other is the time-optimal control law. Results show that the first and second order models with the linear control-law produce a movement time (MT) function with the exact form of the Fitts' Law. The control-law interpretation implies that the effect of target width on MT must be a result of the vertical motion which elevates the hand from the starting point and drops it on the target at the target edge. The time optimal control law did not produce a movement-time formula simular to Fitt's Law.

A Multimedia Intervention on Cardiopulmonary Resuscitation and Advance Directives

PubMed Central

Yamada, Ryo; Galecki, Andrzej T; Goold, Susan Dorr; Hogikyan, Robert V

1999-01-01

OBJECTIVE To assess the effects of a multimedia educational intervention about advance directives (ADs) and cardiopulmonary resuscitation (CPR) on the knowledge, attitude and activity toward ADs and life-sustaining treatments of elderly veterans. DESIGN Prospective randomized controlled, single blind study of educational interventions. SETTING General medicine clinic of a university-affiliated Veterans Affairs Medical Center (VAMC). PARTICIPANTS One hundred seventeen Veterans, 70 years of age or older, deemed able to make medical care decisions. INTERVENTION The control group (n=55) received a handout about ADs in use at the VAMC. The experimental group (n=62) received the same handout, with an additional handout describing procedural aspects and outcomes of CPR, and they watched a videotape about ADs. MEASUREMENTS AND MAIN RESULTS Patients' attitudes and actions toward ADs, CPR and life-sustaining treatments were recorded before the intervention, after it, and 2 to 4 weeks after the intervention through self-administered questionnaires. Only 27.8% of subjects stated that they knew what an AD is in the preintervention questionnaire. This proportion improved in both the experimental and control (87.2% experimental, 52.5% control) subject groups, but stated knowledge of what an AD is was higher in the experimental group (odds ratio = 6.18, p < .001) and this effect, although diminished, persisted in the follow-up questionnaire (OR = 3.92, p = .003). Prior to any intervention, 15% of subjects correctly estimated the likelihood of survival after CPR. This improved after the intervention in the experimental group (OR = 4.27, p = .004), but did not persist at follow-up. In the postintervention questionnaire, few subjects in either group stated that they discussed CPR or ADs with their physician on that day (OR = 0.97, p = NS). CONCLUSION We developed a convenient means of educating elderly male patients regarding CPR and advance directives that improved short

Whose Rule? Whose Law? Filtering America Out of the Rule of Law Mission in Iraq

DTIC Science & Technology

2010-12-01

Iraqi court in Najaf , the holiest city to Shiite Muslims. 16 Only when local AU/ACSC/PALOMINO/AY10 6 citizens protested the ceremony and near mob...Air, Space, & Cyber Forces (Maxwell AFB, AL : The Judge Advocate General’s School , 2009), 337. 7 Ibid. 8 The Judge Advocate General’s Legal Center...Leonard J. Law, “Rule of Law in Iraq : Transitional Justice Under Occupation,” (Monograph presented to the School for Advanced Military Studies, Fort

Law-Based Degree Programs in Business and Their Departments: What's in a Name? (A Comprehensive Study of Undergraduate Law-Based Degrees in AACSB-Accredited Universities)

ERIC Educational Resources Information Center

Miller, Carol J.; Crain, Susan J.

2007-01-01

This study examines undergraduate law-based degree programs in the 404 U.S. universities with undergraduate degrees in business that had Association to Advance Collegiate Schools of Business (AACSB) accreditation in 2005. University Web sites were used to identify and compare law-based undergraduate programs inside business to law-related programs…

Moore's law, lithography, and how optics drive the semiconductor industry

NASA Astrophysics Data System (ADS)

Hutcheson, G. Dan

2018-03-01

When the subject of Moore's Law arises, the important role that lithography plays and how advances in optics have made it all possible is seldom brought up in the world outside of lithography itself. When lithography is mentioned up in the value chain, it's often a critique of how advances are coming too slow and getting far too expensive. Yet advances in lithography are at the core of how Moore's Law is viable. This presentation lays out how technology and the economics of optics in manufacturing interleave to drive the immense value that semiconductors have brought to the world by making it smarter. Continuing these advances will be critical as electronics make the move from smart to cognitive.

California Library Laws, 2008

ERIC Educational Resources Information Center

Smith, Paul G., Ed.

2008-01-01

"California Library Laws 2008" is a selective guide to state laws and related materials that most directly affect the everyday operations of public libraries and organizations that work with public libraries. It is intended as a convenient reference, not as a replacement for the annotated codes or for legal advice. The guide is organized…

Teachers and the Law.

ERIC Educational Resources Information Center

Fischer, Louis; And Others

This book is designed to promote legal literacy for public school teachers. It examines a wide range of constitutional, statutory, and case law that directly affects their work. Its purpose is to provide teachers with the knowledge necessary to comply with the law, assert their rights, and bring violations to the attention of administrators and…

The Influence of law on Strategy

DTIC Science & Technology

2016-05-26

Approved for public release; distribution is unlimited The Influence of Law on Strategy A Monograph by Kevin G. Rousseau School of Advanced...2016 4. TITLE AND SUBTITLE The Influence of Law on Strategy 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S...NOTES 14. ABSTRACT Strategists must understand the legal dynamics that are exerting an increasingly powerful influence on the legitimate use of

Promises, promises for neuroscience and law.

PubMed

Buckholtz, Joshua W; Faigman, David L

2014-09-22

Stunning technical advances in the ability to image the human brain have provoked excited speculation about the application of neuroscience to other fields. The 'promise' of neuroscience for law has been touted with particular enthusiasm. Here, we contend that this promise elides fundamental conceptual issues that limit the usefulness of neuroscience for law. Recommendations for overcoming these challenges are offered. Copyright © 2014 Elsevier Ltd. All rights reserved.

Advance directives as a tool to respect patients' values and preferences: discussion on the case of Alzheimer's disease.

PubMed

Porteri, Corinna

2018-02-20

The proposal of the new criteria for the diagnosis of Alzheimer's disease (AD) based on biomarker data is making possible a diagnosis of AD at the mild cognitive impairment (MCI) or predementia/prodromal- stage. Given the present lack of effective treatments for AD, the opportunity for the individuals to personally take relevant decisions and plan for their future before and if cognitive deterioration occurs is one the main advantages of an early diagnosis. Advance directives are largely seen as an effective tool for planning medical care in the event the subject becomes incompetent. Nevertheless, their value has been questioned with regard to people with dementia by scholars who refer to the arguments of personal identity and of patient's changing interests before and after the onset of dementia. In this paper, I discuss the value of advance directives in Alzheimer's disease and other kind of dementia. Despite critics, I argue that advance directives are especially advisable in dementia and provide reasons in favor of their promotion at an early stage of the disease as a valuable tool to respect patients' values and preferences on medical treatment, including participation in research and end of life decisions. I mainly support advance directives that include both decisions regarding health care and the appointment of an attorney in fact. I conclude that patients with AD at a prodromal or early stage should be offered the opportunity to execute an advance directive, and that not to honor a demented individual's directive would be an unacceptable form of discrimination towards those patients.

Completion of Advance Directives: Do Social Work Preadmission Interviews Make a Difference?

ERIC Educational Resources Information Center

Johnson, Yvonne M.; Stadel, Vivian L.

2007-01-01

Objectives: This study tests the efficacy of a preadmission, educational interview on advance directives, in this case, health care proxies (HCPs) offered to elective, orthopedic patients. Method: Using a quasi-experimental design, participants (n = 54) are assigned to either treatment group (who received the educational interview, conducted by a…

Zipf's word frequency law in natural language: a critical review and future directions.

PubMed

Piantadosi, Steven T

2014-10-01

The frequency distribution of words has been a key object of study in statistical linguistics for the past 70 years. This distribution approximately follows a simple mathematical form known as Zipf's law. This article first shows that human language has a highly complex, reliable structure in the frequency distribution over and above this classic law, although prior data visualization methods have obscured this fact. A number of empirical phenomena related to word frequencies are then reviewed. These facts are chosen to be informative about the mechanisms giving rise to Zipf's law and are then used to evaluate many of the theoretical explanations of Zipf's law in language. No prior account straightforwardly explains all the basic facts or is supported with independent evaluation of its underlying assumptions. To make progress at understanding why language obeys Zipf's law, studies must seek evidence beyond the law itself, testing assumptions and evaluating novel predictions with new, independent data.

Definition and preliminary design of the LAWS (Laser Atmospheric Wind Sounder), volume 2, phase 2

NASA Technical Reports Server (NTRS)

1992-01-01

Accurate knowledge of winds is critical to our understanding of the earth's climate and to our ability to predict climate change. Winds are a fundamental component of highly nonlinear interactions between oceans, land surfaces, and the atmosphere. Interactions at these interfaces are the focus of much climate change research. Although wind information is critical for advancing our understanding, currently most of our description of atmospheric motion is obtained indirectly - i.e., derived from observations of temperature and moisture through geostrophic relationships. Direct measurement of winds over the globe is limited to land-based rawinsonde surface stations and a few ship/aircraft reports. Cloud track winds using satellite imagery are calculated but must be used with great care. The LAWS mission objective, therefore, is to provide diurnal and global direct observations of winds - an observation that will incrementally enhance our knowledge of the earth's climate and physical processes responsible for its change. This document is Volume 2 of the LAWS Phase 2 Final Study Report and describes the definition and preliminary design of the LAWS instrument, together with details of the laser breadboard program conducted during the last 18 months of the program.

California Library Laws, 2009

ERIC Educational Resources Information Center

Smith, Paul G., Ed.

2009-01-01

California Library Laws 2009 is a selective guide to state laws and related materials that most directly affect the everyday operations of public libraries and organizations that work with public libraries. It is intended as a convenient reference, not as a replacement for the annotated codes or for legal advice. The guide is organized as follows.…

Transition of advanced technology to military, homeland security, and law enforcement users

NASA Astrophysics Data System (ADS)

Jarrett, Stephen M.

2004-09-01

With the attack on the United States and the subsequent war on terror and the wars in Afghanistan and Iraq a need has been exposed for the transition of technology to all of our defenders both combat forces on the foreign battlefield and domestic forces here at home. The establishment of the Department of Homeland Security has also provided a focus on inserting technology to dramatically improve the capability of airport security forces, law enforcement, and all first responder networks. The drastic increase in the use of Special Forces in combat has also required new advanced technology capabilities at a much faster rate of development than the standard military procurement system. Technology developers must address the questions of interoperability, cost, commercialization, of how these groups will use the technology delivered and the adoption criteria of users in the deployment environment. The successful transition to the field must address the formation of complex concepts of operations in the user's adoption criteria. Prototype transition for two systems, a pocket infrared camera and an acoustic/seismic detector, will be highlighted in their effect on the wars in Iraq and Afghanistan and in the heightening of homeland security.

Advance Care Planning Beyond Advance Directives: Perspectives from Patients and Surrogates

PubMed Central

McMahan, Ryan; Knight, Sara J.; Fried, Terri R.; Sudore, Rebecca L.

2014-01-01

Context Advance care planning (ACP) has focused on documenting life-sustaining treatment preferences in advance directives (ADs). ADs alone may be insufficient to prepare diverse patients and surrogates for complex medical decisions. Objectives To understand what steps best prepare patients and surrogates for decision making. Methods We conducted 13 English/Spanish focus groups with participants from a Veterans Affairs and county hospital and the community. Seven groups included patients (n=38) aged ≥65 years, who reported making serious medical decisions. Six separate groups included surrogates (n=31), aged ≥18 years, who made decisions for others. Semi-structured focus groups asked what activities best prepared participants for decision making. Two investigators independently coded data and performed thematic content analysis. Disputes were resolved by consensus. Results Mean±SD patient age was 78±8 years and 61% were non-white. Mean±SD surrogate age was 57±10 years and 91% were non-white. Qualitative analysis identified four overarching themes about how to best prepare for decision making: 1) identify values based on past experiences and quality of life, 2) choose surrogates wisely and verify they understand their role, 3) decide whether to grant leeway in surrogate decision making, and 4) inform other family and friends of one's wishes to prevent conflict. Conclusion Beyond ADs, patients and surrogates recommend several additional steps to prepare for medical decision making including using past experiences to identify values, verifying the surrogate understands their role, deciding whether to grant surrogates leeway, and informing other family and friends of one's wishes. Future ACP interventions should consider incorporating these additional ACP activities. PMID:23200188

A study on laws related to women's welfare.

PubMed

Kim, E

1991-01-01

Since 1980, the domestic policy of every Korean government has focused on the construction of a welfare society, yet real change remains elusive, leaving women particularly neglected. This study examines social security legislation, especially the laws that define the status and welfare of women with the goal of advancing women's welfare and eliminating sexual discrimination against them. Welfare laws and literature were collected and examined from Korea and aboard, and facilities were visited. This paper reviews: 1) the theoretical background of women's welfare including the feminist critique and strategies for the welfare state and social welfare, and the significance and necessity of women's welfare; 2) women's welfare: international treaties and trends, including the World Declaration of Human Rights, international agreements on human rights, the International Labor Organization Treaty, the UN Convention on the Elimination of Sexual Discrimination Against Women, and the women's development strategies toward the year 2000; 3) the analysis of the laws and regulations related to women's welfare, including the systematic organization of women's welfare law (judicial, and systematic organization by applicable clients), the constitutional basis of the women's welfare related legislation and legal principles, the main feature and problems of the women's welfare related legislation, e.g. the Social Security Act: the National Pensions Act, Medical Insurance Act, the Livelihood Protection Act, Mother-child Welfare Act, Child Welfare Act, the Anti-prostitution Act, and the Gender Equal Employment Act, and 4) the direction of revision of the women's welfare related legislation including the revision and legislation of women's welfare related laws, restructuring of the delivery system, and the formation of proper environment conducive to the realization of women's welfare.

HER Story: The Next Chapter in HER-2-Directed Therapy for Advanced Breast Cancer

PubMed Central

Joy, Anil A.; Rayson, Daniel; McLeod, Deanna; Brezden-Masley, Christine; Boileau, Jean-François; Gelmon, Karen A.

2013-01-01

Untreated human epidermal growth factor receptor-2 (HER-2)-positive advanced breast cancer (ABC) is an aggressive disease, associated with a poor prognosis and short overall survival. HER-2-directed therapy prolongs both time to disease progression and overall survival when combined with chemotherapy and has become the standard of care for those with HER-2-positive breast cancer in the early and advanced settings. Despite the remarkable therapeutic impact HER-2-directed therapy has had on disease outcomes, some patients with HER-2-positive disease will have primary resistant disease and others will respond initially but will eventually have progression, underscoring the need for other novel therapeutic options. This article reviews recent phase III trial data and discusses a practical approach to sequencing of HER-2-directed therapy in patients with HER-2-positive ABC. The significant cumulative survival gains seen in these trials are slowly reshaping the landscape of HER-2-positive ABC outcomes. PMID:24212500

On recent advances and future research directions for computational fluid dynamics

NASA Technical Reports Server (NTRS)

Baker, A. J.; Soliman, M. O.; Manhardt, P. D.

1986-01-01

This paper highlights some recent accomplishments regarding CFD numerical algorithm constructions for generation of discrete approximate solutions to classes of Reynolds-averaged Navier-Stokes equations. Following an overview of turbulent closure modeling, and development of appropriate conservation law systems, a Taylor weak-statement semi-discrete approximate solution algorithm is developed. Various forms for completion to the final linear algebra statement are cited, as are a range of candidate numerical linear algebra solution procedures. This development sequence emphasizes the key building blocks of a CFD RNS algorithm, including solution trial and test spaces, integration procedure and added numerical stability mechanisms. A range of numerical results are discussed focusing on key topics guiding future research directions.

Aggression, science, and law: The origins framework. Introduction.

PubMed

Victoroff, Jeff

2009-01-01

Human societies have formalized instincts for compliance with reciprocal altruism in laws that sanction some aggression and not other aggression. Neuroscience makes steady advances toward measurements of various aspects of brain function pertinent to the aggressive behaviors that laws are designed to regulate. Consciousness, free will, rationality, intent, reality testing, empathy, moral reasoning, and capacity for self-control are somewhat subject to empirical assessment. The question becomes: how should law accommodate the wealth of information regarding these elements of mind that the science of aggression increasingly makes available? This essay discusses the evolutionary purpose of aggression, the evolutionary purpose of law, the problematic assumptions of the mens rea doctrine, and the prospects for applying the neuroscience of aggression toward the goal of equal justice for unequal minds. Nine other essays are introduced, demonstrating how each of them fits into the framework of the permanent debate about neuroscience and justice. It is concluded that advances in the science of human aggression will have vital, but biologically limited, impact on the provision of justice.

The business of human embryonic stem cell research and an international analysis of relevant laws.

PubMed

De Trizio, Ella; Brennan, Christopher S

2004-01-01

Few sciences have held out such therapeutic promise and correspondingly stirred so much controversy in countries throughout the world as the developing science surrounding human embryonic stem cells. Since the first reported development of several lines of human embryonic stem cells in 1988, many governments around the world have attempted to address the thorny ethical issues raised by human embryonic stem cell research by the passage of laws. In some cases these laws have directly regulated governmental funding of the science; in other cases they have created a legal environment that has either encouraged or discouraged both governmental and private funding of the science. This article first differentiates human embryonic stem cells from other types of stem cells and frames the ethical controversy surrounding human embryonic stem cell research, then surveys laws governing human embryonic stem cell research in various scientifically advanced countries located throughout the Pacific Rim, Europe and North America and explains the impact these laws have had on governmental and private funding of human embryonic stem cell research.

Recovery Act: Advanced Direct Methanol Fuel Cell for Mobile Computing

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fletcher, James H.; Cox, Philip; Harrington, William J

2013-09-03

ABSTRACT Project Title: Recovery Act: Advanced Direct Methanol Fuel Cell for Mobile Computing PROJECT OBJECTIVE The objective of the project was to advance portable fuel cell system technology towards the commercial targets of power density, energy density and lifetime. These targets were laid out in the DOE’s R&D roadmap to develop an advanced direct methanol fuel cell power supply that meets commercial entry requirements. Such a power supply will enable mobile computers to operate non-stop, unplugged from the wall power outlet, by using the high energy density of methanol fuel contained in a replaceable fuel cartridge. Specifically this project focusedmore » on balance-of-plant component integration and miniaturization, as well as extensive component, subassembly and integrated system durability and validation testing. This design has resulted in a pre-production power supply design and a prototype that meet the rigorous demands of consumer electronic applications. PROJECT TASKS The proposed work plan was designed to meet the project objectives, which corresponded directly with the objectives outlined in the Funding Opportunity Announcement: To engineer the fuel cell balance-of-plant and packaging to meet the needs of consumer electronic systems, specifically at power levels required for mobile computing. UNF used existing balance-of-plant component technologies developed under its current US Army CERDEC project, as well as a previous DOE project completed by PolyFuel, to further refine them to both miniaturize and integrate their functionality to increase the system power density and energy density. Benefits of UNF’s novel passive water recycling MEA (membrane electrode assembly) and the simplified system architecture it enabled formed the foundation of the design approach. The package design was hardened to address orientation independence, shock, vibration, and environmental requirements. Fuel cartridge and fuel subsystems were improved to ensure

Beyond competence: advance directives in dementia research.

PubMed

Jongsma, Karin Rolanda; van de Vathorst, Suzanne

2015-01-01

Dementia is highly prevalent and incurable. The participation of dementia patients in clinical research is indispensable if we want to find an effective treatment for dementia. However, one of the primary challenges in dementia research is the patients' gradual loss of the capacity to consent. Patients with dementia are characterized by the fact that, at an earlier stage of their life, they were able to give their consent to participation in research. Therefore, the phase when patients are still competent to decide offers a valuable opportunity to authorize research, by using an advance research directive (ARD). Yet, the use of ARDs as an authorization for research participation remains controversial. In this paper we discuss the role of autonomous decision-making and the protection of incompetent research subjects. We will show why ARDs are a morally defensible basis for the inclusion of this population in biomedical research and that the use of ARDs is compatible with the protection of incompetent research subjects.

Improving Law Enforcement Cross Cultural Competencies through Continued Education

ERIC Educational Resources Information Center

Sereni-Massinger, Christine; Wood, Nancy

2016-01-01

Over the last thirty years Community Oriented Policing (COP) has spawned advancements in creating community partnerships with law enforcement agencies. Agencies that focus on such partnerships have served to reduce crime and resolve conflict. However, community opinions towards law enforcement have become increasingly negative due to recent civil…

Nonlinear Dynamic Inversion Baseline Control Law: Flight-Test Results for the Full-scale Advanced Systems Testbed F/A-18 Airplane

NASA Technical Reports Server (NTRS)

Miller, Christopher J.

2011-01-01

A model reference nonlinear dynamic inversion control law has been developed to provide a baseline controller for research into simple adaptive elements for advanced flight control laws. This controller has been implemented and tested in a hardware-in-the-loop simulation and in flight. The flight results agree well with the simulation predictions and show good handling qualities throughout the tested flight envelope with some noteworthy deficiencies highlighted both by handling qualities metrics and pilot comments. Many design choices and implementation details reflect the requirements placed on the system by the nonlinear flight environment and the desire to keep the system as simple as possible to easily allow the addition of the adaptive elements. The flight-test results and how they compare to the simulation predictions are discussed, along with a discussion about how each element affected pilot opinions. Additionally, aspects of the design that performed better than expected are presented, as well as some simple improvements that will be suggested for follow-on work.

Competence to Complete Psychiatric Advance Directives: Effects of Facilitated Decision Making

PubMed Central

Swanson, Jeffrey W.; Appelbaum, Paul S.; Swartz, Marvin S.; Ferron, Joelle; Van Dorn, Richard A.; Wagner, H. Ryan

2013-01-01

Psychiatric advance directives (PADs) statutes presume competence to complete these documents, but the range and dimensions of decisional competence among people who actually complete PADs is unknown. This study examines clinical and neuropsychological correlates of performance on a measure to assess competence to complete PADs and investigates the effects of a facilitated PAD intervention on decisional capacity. N = 469 adults with psychotic disorders were interviewed at baseline and then randomly assigned to either a control group in which they received written materials about PADs or to an intervention group in which they were offered an opportunity to meet individually with a trained facilitator to create a PAD. At baseline, domains on the Decisional Competence Assessment Tool for PADs (DCAT-PAD) were most strongly associated with IQ, verbal memory, abstract thinking, and psychiatric symptoms. At one-month follow-up, participants in the intervention group showed more improvement on the DCAT-PAD than controls, particularly among participants with pre-morbid IQ estimates below the median of 100. The results suggest that PAD facilitation is an effective method to boost competence of cognitively-impaired clients to write PADs and make treatment decisions within PADs, thereby maximizing the chances their advance directives will be valid. PMID:17294136

Power-law versus log-law in wall-bounded turbulence: A large-eddy simulation perspective

NASA Astrophysics Data System (ADS)

Cheng, W.; Samtaney, R.

2014-01-01

The debate whether the mean streamwise velocity in wall-bounded turbulent flows obeys a log-law or a power-law scaling originated over two decades ago, and continues to ferment in recent years. As experiments and direct numerical simulation can not provide sufficient clues, in this study we present an insight into this debate from a large-eddy simulation (LES) viewpoint. The LES organically combines state-of-the-art models (the stretched-vortex model and inflow rescaling method) with a virtual-wall model derived under different scaling law assumptions (the log-law or the power-law by George and Castillo ["Zero-pressure-gradient turbulent boundary layer," Appl. Mech. Rev. 50, 689 (1997)]). Comparison of LES results for Reθ ranging from 105 to 1011 for zero-pressure-gradient turbulent boundary layer flows are carried out for the mean streamwise velocity, its gradient and its scaled gradient. Our results provide strong evidence that for both sets of modeling assumption (log law or power law), the turbulence gravitates naturally towards the log-law scaling at extremely large Reynolds numbers.

NASA and the practice of space law

NASA Technical Reports Server (NTRS)

Hosenball, S. N.

1985-01-01

The paper discusses the need for increased awareness in space law due to advances in space technology and a trend toward commercialization of space. A list of national and international treaties, conventions, agreements, laws, and regulations relevant to space activities is presented. NASA lawyers specialize in international and municipal laws that affect the NASA space mission; an example of the lawyers working with insurance companies in negotiating the first Space Shuttle liability policy is provided. The increased participation of the public sector in space activities, for example, the commercialization of the Space Shuttle transportation system, is examined.

The neuroeconomic path of the law.

PubMed Central

Hoffman, Morris B

2004-01-01

Advances in evolutionary biology, experimental economics and neuroscience are shedding new light on age-old questions about right and wrong, justice, freedom, the rule of law and the relationship between the individual and the state. Evidence is beginning to accumulate suggesting that humans evolved certain fundamental behavioural predispositions grounded in our intense social natures, that those predispositions are encoded in our brains as a distribution of probable behaviours, and therefore that there may be a core of universal human law. PMID:15590608

Will Moores law be sufficient?

DOE Office of Scientific and Technical Information (OSTI.GOV)

DeBenedictis, Erik P.

2004-07-01

It seems well understood that supercomputer simulation is an enabler for scientific discoveries, weapons, and other activities of value to society. It also seems widely believed that Moore's Law will make progressively more powerful supercomputers over time and thus enable more of these contributions. This paper seeks to add detail to these arguments, revealing them to be generally correct but not a smooth and effortless progression. This paper will review some key problems that can be solved with supercomputer simulation, showing that more powerful supercomputers will be useful up to a very high yet finite limit of around 1021 FLOPSmore » (1 Zettaflops) . The review will also show the basic nature of these extreme problems. This paper will review work by others showing that the theoretical maximum supercomputer power is very high indeed, but will explain how a straightforward extrapolation of Moore's Law will lead to technological maturity in a few decades. The power of a supercomputer at the maturity of Moore's Law will be very high by today's standards at 1016-1019 FLOPS (100 Petaflops to 10 Exaflops), depending on architecture, but distinctly below the level required for the most ambitious applications. Having established that Moore's Law will not be that last word in supercomputing, this paper will explore the nearer term issue of what a supercomputer will look like at maturity of Moore's Law. Our approach will quantify the maximum performance as permitted by the laws of physics for extension of current technology and then find a design that approaches this limit closely. We study a 'multi-architecture' for supercomputers that combines a microprocessor with other 'advanced' concepts and find it can reach the limits as well. This approach should be quite viable in the future because the microprocessor would provide compatibility with existing codes and programming styles while the 'advanced' features would provide a boost to the limits of performance.« less

Toolboxes for cyanobacteria: Recent advances and future direction.

PubMed

Sun, Tao; Li, Shubin; Song, Xinyu; Diao, Jinjin; Chen, Lei; Zhang, Weiwen

2018-05-03

Photosynthetic cyanobacteria are important primary producers and model organisms for studying photosynthesis and elements cycling on earth. Due to the ability to absorb sunlight and utilize carbon dioxide, cyanobacteria have also been proposed as renewable chassis for carbon-neutral "microbial cell factories". Recent progresses on cyanobacterial synthetic biology have led to the successful production of more than two dozen of fuels and fine chemicals directly from CO 2 , demonstrating their potential for scale-up application in the future. However, compared with popular heterotrophic chassis like Escherichia coli and Saccharomyces cerevisiae, where abundant genetic tools are available for manipulations at levels from single gene, pathway to whole genome, limited genetic tools are accessible to cyanobacteria. Consequently, this significant technical hurdle restricts both the basic biological researches and further development and application of these renewable systems. Though still lagging the heterotrophic chassis, the vital roles of genetic tools in tuning of gene expression, carbon flux re-direction as well as genome-wide manipulations have been increasingly recognized in cyanobacteria. In recent years, significant progresses on developing and introducing new and efficient genetic tools have been made for cyanobacteria, including promoters, riboswitches, ribosome binding site engineering, clustered regularly interspaced short palindromic repeats/CRISPR-associated nuclease (CRISPR/Cas) systems, small RNA regulatory tools and genome-scale modeling strategies. In this review, we critically summarize recent advances on development and applications as well as technical limitations and future directions of the genetic tools in cyanobacteria. In addition, toolboxes feasible for using in large-scale cultivation are also briefly discussed. Copyright © 2018 Elsevier Inc. All rights reserved.

Cathodal transcranial direct current stimulation can stabilize perception of movement: Evidence from the two-thirds power law illusion.

PubMed

Scocchia, Lisa; Bolognini, Nadia; Convento, Silvia; Stucchi, Natale

2015-11-16

Human movements conform to specific kinematic laws of motion. One of such laws, the "two-thirds power law", describes the systematic co-variation between curvature and velocity of body movements. Noticeably, the same law also influences the perception of moving stimuli: the velocity of a dot moving along a curvilinear trajectory is perceived as uniform when the dot kinematics complies with the two-thirds power law. Instead, if the dot moves at constant speed, its velocity is perceived as highly non-uniform. This dynamic visual illusion points to a strong coupling between action and perception; however, how this coupling is implemented in the brain remains elusive. In this study, we tested whether the premotor cortex (PM) and the primary visual cortex (V1) play a role in the illusion by means of transcranial Direct Current Stimulation (tDCS). All participants underwent three tDCS sessions during which they received active or sham cathodal tDCS (1.5mA) over PM or V1 of the left hemisphere. During tDCS, participants were required to adjust the velocity of a dot moving along an elliptical trajectory until it looked uniform across the whole trajectory. Results show that occipital tDCS decreases the illusion variability both within and across participants, as compared to sham tDCS. This means that V1 stimulation increases individual sensitivity to the illusory motion and also increases coherence across different observers. Conversely, the illusion seems resistant to tDCS in terms of its magnitude, with cathodal stimulation of V1 or PM not affecting the amount of the illusory effect. Our results provide evidence for strong visuo-motor coupling in visual perception: the velocity of a dot moving along an elliptical trajectory is perceived as uniform only when its kinematics closely complies to the same law of motion that constrains human movement production. Occipital stimulation by cathodal tDCS can stabilize such illusory percept. Copyright © 2015 Elsevier Ireland Ltd

What explains racial differences in the use of advance directives and attitudes toward hospice care?

PubMed

Johnson, Kimberly S; Kuchibhatla, Maragatha; Tulsky, James A

2008-10-01

Cultural beliefs and values are thought to account for differences between African Americans and whites in the use of advance directives and beliefs about hospice care, but few data clarify which beliefs and values explain these differences. Two hundred five adults aged 65 and older who received primary care in the Duke University Health System were surveyed. The survey included five scales: Hospice Beliefs and Attitudes, Preferences for Care, Spirituality, Healthcare System Distrust, and Beliefs About Dying and Advance Care Planning. African Americans were less likely than white subjects to have completed an advance directive (35.5% vs 67.4%, P<.001) and had less favorable beliefs about hospice care (Hospice Beliefs and Attitudes Scale score, P<.001). African Americans were more likely to express discomfort discussing death, want aggressive care at the end of life, have spiritual beliefs that conflict with the goals of palliative care, and distrust the healthcare system. In multivariate analyses, none of these factors alone completely explained racial differences in possession of an advance directive or beliefs about hospice care, but when all of these factors were combined, race was no longer a significant predictor of either of the two outcomes. These findings suggest that ethnicity is a marker of common cultural beliefs and values that, in combination, influence decision-making at the end of life. This study has implications for the design of healthcare delivery models and programs that provide culturally sensitive end-of-life care to a growing population of ethnically diverse older adults.

Origination of medical advance directives among nursing home residents with and without serious mental illness.

PubMed

Cai, Xueya; Cram, Peter; Li, Yue

2011-01-01

Nursing home residents with serious mental illness need a high level of general medical and end-of-life services. This study tested whether persons with serious mental illness are as likely as other nursing home residents to make informed choices about treatments through medical advance care plans. Secondary analyses were conducted with data from a 2004 national survey of nursing home residents with (N=1,769) and without (N=11,738) serious mental illness. Bivariate and multivariate analyses determined differences in documented advance care plans, including living wills; do-not-resuscitate and do-not-hospitalize orders; and orders concerning restriction of feeding tube, medication, or other treatments. The overall rates of having any of the four advance care plans were 57% and 68% for residents with and without serious mental illness, respectively (p<.001). Residents with serious mental illness also showed lower rates for individual advance care plans. In a multivariate analysis that adjusted for resident and facility characteristics (N=1,174 nursing homes) as well as survey procedures, serious mental illness was associated with a 24% reduced odds of having any advance directives (adjusted odds ratio=.76, 95% confidence interval=.66-.87, p<.001). Similar results were found for individual documented plans. Among U.S. nursing home residents, those with serious mental illness were less likely than others to have written medical advance directives. Future research is needed to help understand both resident factors (such as inappropriate behaviors, impaired communication skills, and disrupted family support) and provider factors (including training, experience, and attitude) that underlie this finding.

The law's interface with expanding technology

NASA Technical Reports Server (NTRS)

Green, H. P.

1972-01-01

The role of the law in technology assessment is described in generalized terms of a legal system as it confronts expanding technology. The functions of a technology assessment are considered to be twofold; provide for legislative action designed to channel technological advance along lines which are regarded as optimal from the standpoint of society's interests; and encourage and promote legislative action which will deal decisively with the potential disruptions and injuries caused by technology at a much earlier stage of the growth of the technology than is feasible under the present legal system. It is concluded that since new law always has a disruptive effect on expectations and commitments arrived at under old law, it is generally desirable that new legislation should make the least possible change in the law consistant with accomplishing the desired objective.

Zipf’s word frequency law in natural language: A critical review and future directions

PubMed Central

2014-01-01

The frequency distribution of words has been a key object of study in statistical linguistics for the past 70 years. This distribution approximately follows a simple mathematical form known as Zipf ’ s law. This article first shows that human language has a highly complex, reliable structure in the frequency distribution over and above this classic law, although prior data visualization methods have obscured this fact. A number of empirical phenomena related to word frequencies are then reviewed. These facts are chosen to be informative about the mechanisms giving rise to Zipf’s law and are then used to evaluate many of the theoretical explanations of Zipf’s law in language. No prior account straightforwardly explains all the basic facts or is supported with independent evaluation of its underlying assumptions. To make progress at understanding why language obeys Zipf’s law, studies must seek evidence beyond the law itself, testing assumptions and evaluating novel predictions with new, independent data. PMID:24664880

A Pictorial Approach to Lenz's Law

NASA Astrophysics Data System (ADS)

Duffy, Andrew

2018-04-01

This paper describes a pictorial approach to Lenz's law that involves following four steps and drawing three pictures to determine the direction of the current induced by a changing magnetic flux. Lenz's law accompanies Faraday's law, stating that, for a closed conducting loop, the induced emf (electromotive force) created by a changing magnetic flux sets up a current in the loop that tends to oppose the change in flux. Students are often confused by this, but drawing a sequence of three pictures can make it clearer to students how Lenz's law is applied.

Advance directives from haematology departments: the patient's freedom of choice and communication with families. A qualitative analysis of 35 written documents.

PubMed

Trarieux-Signol, S; Bordessoule, D; Ceccaldi, J; Malak, S; Polomeni, A; Fargeas, J B; Signol, N; Pauliat, H; Moreau, S

2018-01-02

In France, advance directives are favourably perceived by most of the population, although the drafting rate is low. This ambivalence is challenging because advance directives are meant to promote the autonomy and freedom of choice of patients. The purpose of this study was to analyse the content of advance directives written by patients suffering from malignant haemopathies to better understand how patients put them into practice. These could be relevant as early as the initial diagnosis of haematological malignancies because of the uncertain course of the disease. This was a multicentre, qualitative, descriptive study. The advance directives written by patients with malignant haemopathies treated in one of the six French hospital departments were included in the study from 01/06/2008 to 15/04/2016. A thematic analysis of the advance directives was performed by two researchers: a senior haematologist and a research assistant. The median age of the patients was 69. Most were women (sex ratio: 0.59), living as a couple (57%), with lymphoid pathologies (66%), who were still alive two years after the instructions were written (63%) and had nominated a health care proxy (88.6%). Free texts (62.9%) were richer in content than pre-defined forms. The advance directives were used in three ways: for a purely legal purpose, to focus on medical treatments or actions, or to communicate a message to the family. Three main themes emerged: (1) refusal of medical treatment (100%), in which patients express refusal of life-sustaining care (97.1%). The actual treatments or the moment when they should be limited or stopped were not always mentioned in detail. (2) A desire for effective pain relief to avoid suffering (57.1%) and (3) messages for their family (34.3%), such as funeral arrangements (17.1%) and messages of love or trust (14.3%). Patients who write advance directives are not necessarily at the end of their lives. Their content mainly conveys treatment wishes, although

Power Laws are Disguised Boltzmann Laws

NASA Astrophysics Data System (ADS)

Richmond, Peter; Solomon, Sorin

Using a previously introduced model on generalized Lotka-Volterra dynamics together with some recent results for the solution of generalized Langevin equations, we derive analytically the equilibrium mean field solution for the probability distribution of wealth and show that it has two characteristic regimes. For large values of wealth, it takes the form of a Pareto style power law. For small values of wealth, w<=wm, the distribution function tends sharply to zero. The origin of this law lies in the random multiplicative process built into the model. Whilst such results have been known since the time of Gibrat, the present framework allows for a stable power law in an arbitrary and irregular global dynamics, so long as the market is ``fair'', i.e., there is no net advantage to any particular group or individual. We further show that the dynamics of relative wealth is independent of the specific nature of the agent interactions and exhibits a universal character even though the total wealth may follow an arbitrary and complicated dynamics. In developing the theory, we draw parallels with conventional thermodynamics and derive for the system some new relations for the ``thermodynamics'' associated with the Generalized Lotka-Volterra type of stochastic dynamics. The power law that arises in the distribution function is identified with new additional logarithmic terms in the familiar Boltzmann distribution function for the system. These are a direct consequence of the multiplicative stochastic dynamics and are absent for the usual additive stochastic processes.

Advance directives and the persistent vegetative state in Victoria: a human rights perspective.

PubMed

Porter, Deborah

2005-11-01

With advances in medical technology, it is now possible to sustain the life of a person in a persistent vegetative state (PVS) until a decision is made to withhold or withdraw life-sustaining treatment. Who makes that decision? Under the Medical Treatment Act 1988 (Vic) there is no legally enforceable right for a person to choose, in advance, what intervention that person will and will not accept if he or she ends up in a PVS. The best that can be achieved is that a person can appoint an agent who is empowered to refuse medical treatment on the person's behalf in the event of incompetence. It is suggested that this mechanism ignores two fundamental human rights: self-determination and the inherent right to dignity. This article proposes the development of an advance directive mechanism that provides for a person to refuse, in advance, specified intervention, thereby respecting fundamental human rights and alleviating the existing need for an agent to second-guess a person's desires and best interests.

Advancing sexual health through human rights: the role of the law.

PubMed

Kismödi, Eszter; Cottingham, Jane; Gruskin, Sofia; Miller, Alice M

2015-01-01

Since the International Conference on Population and Development, definitions of sexuality and sexual health have been greatly elaborated alongside widely accepted recognition that sexual health requires respect, protection and fulfilment of human rights. Considerable progress has also been made in enacting or changing laws that affect sexuality and sexual health, in line with human rights standards. These measures include legal guarantees against non-discrimination and violence, decriminalisation of consensual sexual conduct and guaranteeing availability, accessibility, acceptability and quality of sexual health information and services to all. Such legal actions have had positive effects on health and specifically on sexual health, particularly for marginalised populations. Yet in all regions of the world, laws still exist which jeopardise health, including sexual health, and violate human rights. In order to ensure accountability for the rights and health of their populations, states have an obligation to bring their laws into line with international, regional and national human rights standards. These rights-based legal guarantees, while insufficient alone, are essential for effective systems of accountability, achieving positive sexual health outcomes and the respect and protection of human rights.

A Control Law Design Method Facilitating Control Power, Robustness, Agility, and Flying Qualities Tradeoffs: CRAFT

NASA Technical Reports Server (NTRS)

Murphy, Patrick C.; Davidson, John B.

1998-01-01

A multi-input, multi-output control law design methodology, named "CRAFT", is presented. CRAFT stands for the design objectives addressed, namely, Control power, Robustness, Agility, and Flying Qualities Tradeoffs. The methodology makes use of control law design metrics from each of the four design objective areas. It combines eigenspace assignment, which allows for direct specification of eigenvalues and eigenvectors, with a graphical approach for representing the metrics that captures numerous design goals in one composite illustration. Sensitivity of the metrics to eigenspace choice is clearly displayed, enabling the designer to assess the cost of design tradeoffs. This approach enhances the designer's ability to make informed design tradeoffs and to reach effective final designs. An example of the CRAFT methodology applied to an advanced experimental fighter and discussion of associated design issues are provided.

Nurses' knowledge of advance directives and perceived confidence in end-of-life care: a cross-sectional study in five countries.

PubMed

Coffey, Alice; McCarthy, Geraldine; Weathers, Elizabeth; Friedman, M Isabel; Gallo, Katherine; Ehrenfeld, Mally; Chan, Sophia; Li, William H C; Poletti, Piera; Zanotti, Renzo; Molloy, D William; McGlade, Ciara; Fitzpatrick, Joyce J; Itzhaki, Michal

2016-06-01

Nurses' knowledge regarding advance directives may affect their administration and completion in end-of-life care. Confidence among nurses is a barrier to the provision of quality end-of-life care. This study investigated nurses' knowledge of advance directives and perceived confidence in end-of-life care, in Hong Kong, Ireland, Israel, Italy and the USA using a cross-sectional descriptive design (n = 1089). In all countries, older nurses and those who had more professional experience felt more confident managing patients' symptoms at end-of-life and more comfortable stopping preventive medications at end-of-life. Nurses in the USA reported that they have more knowledge and experience of advance directives compared with other countries. In addition, they reported the highest levels of confidence and comfort in dealing with end-of-life care. Although legislation for advance directives does not yet exist in Ireland, nurses reported high levels of confidence in end-of-life care. © 2016 The Authors International Journal of Nursing Practice Published by Wiley Publishing Asia Pty Ltd.

Origination of Medical Advance Directives Among Nursing Home Residents With and Without Serious Mental Illness

PubMed Central

Cai, Xueya; Cram, Peter; Li, Yue

2013-01-01

Objective Nursing home residents with serious mental illness need a high level of general medical and end-of-life services. This study tested whether persons with serious mental illness are as likely as other nursing home residents to make informed choices about treatments through medical advance care plans. Methods Secondary analyses were conducted with data from a 2004 national survey of nursing home residents with serious mental illness (N=1,769) and without (N=11,738). Bivariate and multivariate analyses determined differences in documented advance care plans, including living wills; “do not resuscitate” and “do not hospitalize” orders; and orders concerning restriction of feeding tube, medication, or other treatments. Results The overall rates of having any of the four advance care plans were 57% and 68% for residents with and without serious mental illness, respectively (p<.001). Residents with serious mental illness also showed lower rates for individual advance care plans. In a multivariate analysis that adjusted for resident and facility characteristics (N=1,174 nursing homes) as well as survey procedures, serious mental illness was associated with a 24% reduced odds of having any advance directives (adjusted odds ratio=.76, 95% confidence interval=.66–.87, p<.001). Similar results were found for individual documented plans. Conclusions Among U.S. nursing home residents, those with serious mental illness were less likely than others to have written medical advance directives. Future research is needed to help understand both resident factors (such as inappropriate behaviors, impaired communication skills, and disrupted family support) and provider factors (including training, experience, and attitude) that underlie this finding. PMID:21209301

Advance Directives for End-of-Life Care and the Role of Health Education Specialists: Applying the Theory of Reasoned Action

ERIC Educational Resources Information Center

Tremethick, Mary Jane; Johnson, Maureen K.; Carter, Mary R.

2011-01-01

Quality end-of-life care is subjective and based on individual values and beliefs. An advance directive provides a legal means of communicating these values and beliefs, as well as preferences in regards to end-of-life care when an individual is no longer able to make his or her desires known. In many nations, advance directives are underused…

A Pictorial Approach to Lenz's Law

ERIC Educational Resources Information Center

Duffy, Andrew

2018-01-01

This paper describes a pictorial approach to Lenz's law that involves following four steps and drawing three pictures to determine the direction of the current induced by a changing magnetic flux. Lenz's law accompanies Faraday's law, stating that, for a closed conducting loop, the induced emf (electromotive force) created by a changing magnetic…

Sunshine Laws in Higher Education. State Policy Brief

ERIC Educational Resources Information Center

Hearn, James C.

2017-01-01

Public higher education is a major recipient of state funding and resources. As such, public colleges and universities directly respond to state needs for higher education and are required to provide transparency in decision-making, which is codified in state open-meeting and record laws. These laws, often termed "sunshine laws," present…

Advancing sexual health through human rights: The role of the law

PubMed Central

Kismödi, Eszter; Cottingham, Jane; Gruskin, Sofia; Miller, Alice M.

2015-01-01

Since the International Conference on Population and Development, definitions of sexuality and sexual health have been greatly elaborated alongside widely accepted recognition that sexual health requires respect, protection and fulfilment of human rights. Considerable progress has also been made in enacting or changing laws that affect sexuality and sexual health, in line with human rights standards. These measures include legal guarantees against non-discrimination and violence, decriminalisation of consensual sexual conduct and guaranteeing availability, accessibility, acceptability and quality of sexual health information and services to all. Such legal actions have had positive effects on health and specifically on sexual health, particularly for marginalised populations. Yet in all regions of the world, laws still exist which jeopardise health, including sexual health, and violate human rights. In order to ensure accountability for the rights and health of their populations, states have an obligation to bring their laws into line with international, regional and national human rights standards. These rights-based legal guarantees, while insufficient alone, are essential for effective systems of accountability, achieving positive sexual health outcomes and the respect and protection of human rights. PMID:25539286

Experimental Investigation on the Basic Law of Directional Hydraulic Fracturing Controlled by Dense Linear Multi-Hole Drilling

NASA Astrophysics Data System (ADS)

Zhao, Xinglong; Huang, Bingxiang; Wang, Zhen

2018-06-01

Directional rupture is a significant and routine problem for ground control in mines. Directional hydraulic fracturing controlled by dense linear multi-hole drilling was proposed. The physical model experiment, performed by the large-scale true triaxial hydraulic fracturing experimental system, aims to investigate the basic law of directional hydraulic fracturing controlled by dense linear multi-hole drilling, the impact of three different pumping modes on the initiation and propagation of hydraulic fractures among boreholes are particular investigated. The experimental results indicated that there are mutual impacts among different boreholes during crack propagation, which leads to a trend of fracture connection. Furthermore, during propagation, the fractures not only exhibit an overall bias toward the direction in which the boreholes are scattered but also partially offset against the borehole axes and intersect. The directional fracturing effect of equivalent pumping rate in each borehole is better than the other two pumping modes. In practical applications, because of rock mass heterogeneity, there may be differences in terms of filtration rate and effective input volume in different boreholes; thus, water pressure increase and rupture are not simultaneous in different boreholes. Additionally, if the crack initiation directions of different boreholes at different times are not consistent with each other, more lamellar failure planes will occur, and the mutual influences of these lamellar failure planes cause fractures to extend and intersect.

Gaps in US Animal Welfare Law for Laboratory Animals: Perspectives From an Animal Law Attorney.

PubMed

Frasch, Pamela D

2016-05-01

The use of animals in biomedical, toxicological, and basic research has been common practice, and a tool for scientists and researchers, for many years. And yet, serious conflict continues to exist between those who believe that the use of animals in research will yield scientific results that benefit humans and those who believe such practices are unethical regardless of use or outcome. High-profile undercover cases have further raised public awareness and have put the entire industry under pressure to be transparent, accountable, and aggressive in its adoption of reduction, refinement, and replacement (3R) principles. Many animal law attorneys are deeply frustrated by what they see as weak US laws that are unevenly enforced, especially when compared with legal advances in other countries and regions. This article (1) explores those gaps in US animal welfare laws with an emphasis on the Animal Welfare Act, (2) argues in favor of stronger laws and rigorous enforcement, and (3) suggests steps to advance these goals. These steps include (1) expanding the definition of "animal" in the Animal Welfare Act (AWA), (2) improving and expanding minimum care requirements in USDA regulations, (3) instituting mandatory reporting requirements, improving Institutional Animal Care and Use Committees, and allowing easier accessibility to laboratory reports and plans, (4) adding a citizen suit provision to the AWA, and (5) continuing education about the emotional and social capacities of animals and a stronger commitment to 3R principles. © The Author 2017. Published by Oxford University Press on behalf of the Institute for Laboratory Animal Research. All rights reserved. For permissions, please email: journals.permissions@oup.com.

A model for emergency department end-of-life communications after acute devastating events--part I: decision-making capacity, surrogates, and advance directives.

PubMed

Limehouse, Walter E; Feeser, V Ramana; Bookman, Kelly J; Derse, Arthur

2012-09-01

Making decisions for a patient affected by sudden devastating illness or injury traumatizes a patient's family and loved ones. Even in the absence of an emergency, surrogates making end-of-life treatment decisions may experience negative emotional effects. Helping surrogates with these end-of-life decisions under emergent conditions requires the emergency physician (EP) to be clear, making medical recommendations with sensitivity. This model for emergency department (ED) end-of-life communications after acute devastating events comprises the following steps: 1) determine the patient's decision-making capacity; 2) identify the legal surrogate; 3) elicit patient values as expressed in completed advance directives; 4) determine patient/surrogate understanding of the life-limiting event and expectant treatment goals; 5) convey physician understanding of the event, including prognosis, treatment options, and recommendation; 6) share decisions regarding withdrawing or withholding of resuscitative efforts, using available resources and considering options for organ donation; and 7) revise treatment goals as needed. Emergency physicians should break bad news compassionately, yet sufficiently, so that surrogate and family understand both the gravity of the situation and the lack of long-term benefit of continued life-sustaining interventions. EPs should also help the surrogate and family understand that palliative care addresses comfort needs of the patient including adequate treatment for pain, dyspnea, or anxiety. Part I of this communications model reviews determination of decision-making capacity, surrogacy laws, and advance directives, including legal definitions and application of these steps; Part II (which will appear in a future issue of AEM) covers communication moving from resuscitative to end-of-life and palliative treatment. EPs should recognize acute devastating illness or injuries, when appropriate, as opportunities to initiate end-of-life discussions and to

How to choose a calving law

NASA Astrophysics Data System (ADS)

O'Leary, M.

2014-12-01

Any model of an ocean-terminating ice mass requires a frontal boundary condition, often referred to as a "calving law". The choice of this boundary condition can have complex and poorly-understood effects on the behaviour of the system. Despite this, calving laws are often chosen based on numerical convenience or fashions in the literature. This can often lead to predictions which have "hidden dependencies" on the particular choice of calving law. As an attempt to alleviate this problem, I will show results from a wide variety of calving laws, applied to tidewater glacier scenarios. I will demonstrate how the decadal-scale stability of a tidewater system can put constraints on possible calving laws, and how certain observational phenomena, such as the presence of "pinning points" are largely independent of the choice of calving law. These results can be used by practitioners to decide on appropriate calving laws for the specific problems at hand. They should also be useful to help direct research into new calving laws, and to guide our conception of what an ideal calving law should look like.

Use and Misuse of Laplace's Law in Ophthalmology.

PubMed

Chung, Cheuk Wang; Girard, Michaël J A; Jan, Ning-Jiun; Sigal, Ian A

2016-01-01

Laplace's Law, with its compactness and simplicity, has long been employed in ophthalmology for describing the mechanics of the corneoscleral shell. We questioned the appropriateness of Laplace's Law for computing wall stress in the eye considering the advances in knowledge of ocular biomechanics. In this manuscript we recapitulate the formulation of Laplace's Law, as well as common interpretations and uses in ophthalmology. Using numerical modeling, we study how Laplace's Law cannot account for important characteristics of the eye, such as variations in globe shape and size or tissue thickness, anisotropy, viscoelasticity, or that the eye is a living, dynamic organ. We show that accounting for various geometrical and material factors, excluded from Laplace's Law, can alter estimates of corneoscleral wall stress as much as 456% and, therefore, that Laplace's Law is unreliable. We conclude by illustrating how computational techniques, such as finite element modeling, can account for the factors mentioned above, and are thus more suitable tools to provide quantitative characterization of corneoscleral biomechanics.

Opinions about euthanasia and advanced dementia: a qualitative study among Dutch physicians and members of the general public.

PubMed

Kouwenhoven, Pauline S C; Raijmakers, Natasja J H; van Delden, Johannes J M; Rietjens, Judith A C; van Tol, Donald G; van de Vathorst, Suzanne; de Graeff, Nienke; Weyers, Heleen A M; van der Heide, Agnes; van Thiel, Ghislaine J M W

2015-01-28

The Dutch law states that a physician may perform euthanasia according to a written advance euthanasia directive (AED) when a patient is incompetent as long as all legal criteria of due care are met. This may also hold for patients with advanced dementia. We investigated the differing opinions of physicians and members of the general public on the acceptability of euthanasia in patients with advanced dementia. In this qualitative study, 16 medical specialists, 19 general practitioners, 16 elderly physicians and 16 members of the general public were interviewed and asked for their opinions about a vignette on euthanasia based on an AED in a patient with advanced dementia. Members of the general public perceived advanced dementia as a debilitating and degrading disease. Physicians emphasized the need for direct communication with the patient when making decisions about euthanasia. Respondent from both groups acknowledged difficulties in the assessment of patients' autonomous wishes and the unbearableness of their suffering. Legally, an AED may replace direct communication with patients about their request for euthanasia. In practice, physicians are reluctant to forego adequate verbal communication with the patient because they wish to verify the voluntariness of patients' request and the unbearableness of suffering. For this reason, the applicability of AEDs in advanced dementia seems limited.

Characteristics of Patients With Existing Advance Directives: Evaluating Motivations Around Advance Care Planning.

PubMed

Genewick, Joanne E; Lipski, Dorothy M; Schupack, Katherine M; Buffington, Angela L H

2018-04-01

Although 80% of patients endorse an advance directive (AD), less than 35% of American adults have a documented AD. Much research has been done on barriers to creating ADs; however, there is a paucity of research addressing motivations for creating ADs. Previous research has identified 4 categories of influence for engaging in advance care planning (ACP). This study aimed to quantify the influence of these 4 motivating categories in creating an AD. Participants included 238 adults with documented ADs. Participants completed an 11-item questionnaire addressing 1 of the 4 hypothesized categories of influence in addressing ACP: concern for self; concern for others; expectations about the impact of ACP; and anecdotes, stories, and experiences. Principle component analysis yielded 2 factors representing dignity and personal control (intrinsic factors) and societal and familial influence (extrinsic factors). Intrinsic factors were the primary and most influential motivating factors among participants. A regression analysis of individual motivating factors showed that prior to age 50, the desire to provide guidance about personal preferences for end-of-life care significantly predicted the creation of an AD, whereas after age 50, the urging of family members significantly predicted the creation of an AD. Results indicated that intrinsic factors were the most influential motivator among participants of all ages. Extrinsic factors appeared to be less influential in the decision to create an AD. Motivating factors were also found to vary by age. These results may help physicians be more targeted in discussions surrounding ADs, thus saving time, which physicians identify as the main barrier in engaging in such discussions, while meeting patients' wishes for their physicians to bring up the topic of ADs.

20 CFR 416.1032 - Other Federal laws and regulations.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Other Federal laws and regulations. 416.1032... § 416.1032 Other Federal laws and regulations. The State will comply with the provisions of other Federal laws and regulations that directly affect its responsibilities in carrying out the disability...

20 CFR 416.2223 - Other Federal laws and regulations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Other Federal laws and regulations. 416.2223... § 416.2223 Other Federal laws and regulations. Each State VR agency and alternate participant shall comply with the provisions of other Federal laws and regulations that directly affect its...

20 CFR 404.2123 - Other Federal laws and regulations.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Other Federal laws and regulations. 404.2123....2123 Other Federal laws and regulations. Each State VR agency and alternate participant shall comply with the provisions of other Federal laws and regulations that directly affect its responsibilities in...

20 CFR 416.2223 - Other Federal laws and regulations.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Other Federal laws and regulations. 416.2223... § 416.2223 Other Federal laws and regulations. Each State VR agency and alternate participant shall comply with the provisions of other Federal laws and regulations that directly affect its...

20 CFR 404.1632 - Other Federal laws and regulations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Other Federal laws and regulations. 404.1632... § 404.1632 Other Federal laws and regulations. The State will comply with the provisions of other Federal laws and regulations that directly affect its responsibilities in carrying out the disability...

20 CFR 404.2123 - Other Federal laws and regulations.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Other Federal laws and regulations. 404.2123....2123 Other Federal laws and regulations. Each State VR agency and alternate participant shall comply with the provisions of other Federal laws and regulations that directly affect its responsibilities in...

20 CFR 416.1032 - Other Federal laws and regulations.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Other Federal laws and regulations. 416.1032... § 416.1032 Other Federal laws and regulations. The State will comply with the provisions of other Federal laws and regulations that directly affect its responsibilities in carrying out the disability...

20 CFR 404.1632 - Other Federal laws and regulations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Other Federal laws and regulations. 404.1632... § 404.1632 Other Federal laws and regulations. The State will comply with the provisions of other Federal laws and regulations that directly affect its responsibilities in carrying out the disability...

20 CFR 404.2123 - Other Federal laws and regulations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Other Federal laws and regulations. 404.2123....2123 Other Federal laws and regulations. Each State VR agency and alternate participant shall comply with the provisions of other Federal laws and regulations that directly affect its responsibilities in...

20 CFR 416.1032 - Other Federal laws and regulations.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Other Federal laws and regulations. 416.1032... § 416.1032 Other Federal laws and regulations. The State will comply with the provisions of other Federal laws and regulations that directly affect its responsibilities in carrying out the disability...

20 CFR 416.1032 - Other Federal laws and regulations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Other Federal laws and regulations. 416.1032... § 416.1032 Other Federal laws and regulations. The State will comply with the provisions of other Federal laws and regulations that directly affect its responsibilities in carrying out the disability...

20 CFR 416.2223 - Other Federal laws and regulations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Other Federal laws and regulations. 416.2223... § 416.2223 Other Federal laws and regulations. Each State VR agency and alternate participant shall comply with the provisions of other Federal laws and regulations that directly affect its...

20 CFR 404.1632 - Other Federal laws and regulations.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Other Federal laws and regulations. 404.1632... § 404.1632 Other Federal laws and regulations. The State will comply with the provisions of other Federal laws and regulations that directly affect its responsibilities in carrying out the disability...

20 CFR 404.2123 - Other Federal laws and regulations.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Other Federal laws and regulations. 404.2123....2123 Other Federal laws and regulations. Each State VR agency and alternate participant shall comply with the provisions of other Federal laws and regulations that directly affect its responsibilities in...

20 CFR 404.2123 - Other Federal laws and regulations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Other Federal laws and regulations. 404.2123....2123 Other Federal laws and regulations. Each State VR agency and alternate participant shall comply with the provisions of other Federal laws and regulations that directly affect its responsibilities in...

20 CFR 416.1032 - Other Federal laws and regulations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Other Federal laws and regulations. 416.1032... § 416.1032 Other Federal laws and regulations. The State will comply with the provisions of other Federal laws and regulations that directly affect its responsibilities in carrying out the disability...

20 CFR 404.1632 - Other Federal laws and regulations.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Other Federal laws and regulations. 404.1632... § 404.1632 Other Federal laws and regulations. The State will comply with the provisions of other Federal laws and regulations that directly affect its responsibilities in carrying out the disability...

20 CFR 416.2223 - Other Federal laws and regulations.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Other Federal laws and regulations. 416.2223... § 416.2223 Other Federal laws and regulations. Each State VR agency and alternate participant shall comply with the provisions of other Federal laws and regulations that directly affect its...

20 CFR 404.1632 - Other Federal laws and regulations.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Other Federal laws and regulations. 404.1632... § 404.1632 Other Federal laws and regulations. The State will comply with the provisions of other Federal laws and regulations that directly affect its responsibilities in carrying out the disability...

20 CFR 416.2223 - Other Federal laws and regulations.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Other Federal laws and regulations. 416.2223... § 416.2223 Other Federal laws and regulations. Each State VR agency and alternate participant shall comply with the provisions of other Federal laws and regulations that directly affect its...

Advance (Meta-) Directives for Patients with Dementia who Appear Content: Learning from a Nationwide Survey.

PubMed

Schoene-Seifert, Bettina; Uerpmann, Anna Lena; Gerß, Joachim; Herr, David

2016-04-01

Whether health care professionals should respect a properly executed advance directive (AD) refusing life support in late-stage dementia even if the patient seems contented, is an ethically contested issue. We undertook a nationwide survey to assess this problem and to test a practical solution. Nationwide survey using a questionnaire among 4 stakeholder groups. Germany. Adult Germans (n = 735), among them: dementia-experienced physicians (n = 161), dementia-experienced nurses (n = 191), next of kin (n = 197), and dementia-inexperienced adults (n = 186). Participants were asked about their attitudes on medical decision-making in a vignette case of treatable pneumonia, for their agreement or disagreement on standard ethical arguments in this debate, and for their views on modified versions of the case. One such modification was an explicit anticipation of the conflict in question by the patients themselves. Of our 735 eligible respondents, 25% were unwilling to follow the patient's AD. Standard arguments for and against respecting the directive were endorsed to different degrees. Respondents' unwillingness to follow the directive was significantly decreased (to 16.3%, P < .001), if the advance refusal of pneumonia treatment explicitly indicated that it applied to a patient who appears content in his demented state. Only 8.7% of respondents would disregard an advance refusal of tube feeding. Persons executing ADs forbidding life support in late-stage dementia run some risk that these will not be followed if they later appear "happy" in their dementia. It seems ethically and practically advisable to incorporate an explicit meta-directive for this conflict. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Factors Affecting Long-Term-Care Residents' Decision-Making Processes as They Formulate Advance Directives

ERIC Educational Resources Information Center

Lambert, Heather C.; McColl, Mary Ann; Gilbert, Julie; Wong, Jiahui; Murray, Gale; Shortt, Samuel E. D.

2005-01-01

Purpose: The purpose of this study was to describe factors contributing to the decision-making processes of elderly persons as they formulate advance directives in long-term care. Design and Methods: This study was qualitative, based on grounded theory. Recruitment was purposive and continued until saturation was reached. Nine residents of a…

Investigation and Development of Control Laws for the NASA Langley Research Center Cockpit Motion Facility

NASA Technical Reports Server (NTRS)

Coon, Craig R.; Cardullo, Frank M.; Zaychik, Kirill B.

2014-01-01

The ability to develop highly advanced simulators is a critical need that has the ability to significantly impact the aerospace industry. The aerospace industry is advancing at an ever increasing pace and flight simulators must match this development with ever increasing urgency. In order to address both current problems and potential advancements with flight simulator techniques, several aspects of current control law technology of the National Aeronautics and Space Administration (NASA) Langley Research Center's Cockpit Motion Facility (CMF) motion base simulator were examined. Preliminary investigation of linear models based upon hardware data were examined to ensure that the most accurate models are used. This research identified both system improvements in the bandwidth and more reliable linear models. Advancements in the compensator design were developed and verified through multiple techniques. The position error rate feedback, the acceleration feedback and the force feedback were all analyzed in the heave direction using the nonlinear model of the hardware. Improvements were made using the position error rate feedback technique. The acceleration feedback compensator also provided noteworthy improvement, while attempts at implementing a force feedback compensator proved unsuccessful.

Advance Care Planning in an Accountable Care Organization Is Associated with Increased Advanced Directive Documentation and Decreased Costs

PubMed Central

Kim, Minchul; Franciskovich, Chris M.; Weinberg, Jason E.; Svendsen, Jessica D.; Fehr, Linda S.; Funk, Amy; Sawicki, Robert; Asche, Carl V.

2018-01-01

Abstract Background: Advance care planning (ACP) documents patient wishes and increases awareness of palliative care options. Objective: To study the association of outpatient ACP with advanced directive documentation, utilization, and costs of care. Design: This was a case–control study of cases with ACP who died matched 1:1 with controls. We used 12 months of data pre-ACP/prematch and predeath. We compared rates of documentation with logit model regression and conducted a difference-in-difference analysis using generalized linear models for utilization and costs. Setting/subjects: Medicare beneficiaries attributed to a large rural-suburban-small metro multisite accountable care organization from January 2013 to April 2016, with cross reference to ACP facilitator logs to find cases. Measurements: The presence of advance directive forms was verified by chart review. Cost analysis included all utilization and costs billed to Medicare. Results: We matched 325 cases and 325 controls (51.1% female and 48.9% male, mean age 81). 320/325 (98.5%) ACP versus 243/325 (74.8%) of controls had a Healthcare Power of Attorney (odds ratio [OR] 21.6, 95% CI 8.6–54.1) and 172/325(52.9%) ACP versus 145/325 (44.6%) controls had Practitioner Orders for Life Sustaining Treatment (OR 1.40, 95% CI 1.02–1.90) post-ACP/postmatch. Adjusted results showed ACP cases had fewer inpatient admissions (−0.37 admissions, 95% CI −0.66 to −0.08), and inpatient days (−3.66 days, 95% CI −6.23 to −1.09), with no differences in hospice, hospice days, skilled nursing facility use, home health use, 30-day readmissions, or emergency department visits. Adjusted costs were $9,500 lower in the ACP group (95% CI −$16,207 to −$2,793). Conclusions: ACP increases documentation and was associated with a reduction in overall costs driven primarily by a reduction in inpatient utilization. Our data set was limited by small numbers of minorities and cancer patients. PMID:29206564

Advance Care Planning in an Accountable Care Organization Is Associated with Increased Advanced Directive Documentation and Decreased Costs.

PubMed

Bond, William F; Kim, Minchul; Franciskovich, Chris M; Weinberg, Jason E; Svendsen, Jessica D; Fehr, Linda S; Funk, Amy; Sawicki, Robert; Asche, Carl V

2018-04-01

Advance care planning (ACP) documents patient wishes and increases awareness of palliative care options. To study the association of outpatient ACP with advanced directive documentation, utilization, and costs of care. This was a case-control study of cases with ACP who died matched 1:1 with controls. We used 12 months of data pre-ACP/prematch and predeath. We compared rates of documentation with logit model regression and conducted a difference-in-difference analysis using generalized linear models for utilization and costs. Medicare beneficiaries attributed to a large rural-suburban-small metro multisite accountable care organization from January 2013 to April 2016, with cross reference to ACP facilitator logs to find cases. The presence of advance directive forms was verified by chart review. Cost analysis included all utilization and costs billed to Medicare. We matched 325 cases and 325 controls (51.1% female and 48.9% male, mean age 81). 320/325 (98.5%) ACP versus 243/325 (74.8%) of controls had a Healthcare Power of Attorney (odds ratio [OR] 21.6, 95% CI 8.6-54.1) and 172/325(52.9%) ACP versus 145/325 (44.6%) controls had Practitioner Orders for Life Sustaining Treatment (OR 1.40, 95% CI 1.02-1.90) post-ACP/postmatch. Adjusted results showed ACP cases had fewer inpatient admissions (-0.37 admissions, 95% CI -0.66 to -0.08), and inpatient days (-3.66 days, 95% CI -6.23 to -1.09), with no differences in hospice, hospice days, skilled nursing facility use, home health use, 30-day readmissions, or emergency department visits. Adjusted costs were $9,500 lower in the ACP group (95% CI -$16,207 to -$2,793). ACP increases documentation and was associated with a reduction in overall costs driven primarily by a reduction in inpatient utilization. Our data set was limited by small numbers of minorities and cancer patients.

Library Law Handbook: State Laws Relating to Michigan Libraries. 1993 Edition.

ERIC Educational Resources Information Center

Michigan Library, Lansing.

This document is a compilation of state laws relating to Michigan libraries, intended as a tool for library managers and as an expression of continued commitment to strengthening library services throughout the state. It reprints legislation directly related to libraries of all levels, including: library networks; regional libraries: district…

Consciousness in humans and non-human animals: recent advances and future directions

PubMed Central

Boly, Melanie; Seth, Anil K.; Wilke, Melanie; Ingmundson, Paul; Baars, Bernard; Laureys, Steven; Edelman, David B.; Tsuchiya, Naotsugu

2013-01-01

This joint article reflects the authors' personal views regarding noteworthy advances in the neuroscience of consciousness in the last 10 years, and suggests what we feel may be promising future directions. It is based on a small conference at the Samoset Resort in Rockport, Maine, USA, in July of 2012, organized by the Mind Science Foundation of San Antonio, Texas. Here, we summarize recent advances in our understanding of subjectivity in humans and other animals, including empirical, applied, technical, and conceptual insights. These include the evidence for the importance of fronto-parietal connectivity and of “top-down” processes, both of which enable information to travel across distant cortical areas effectively, as well as numerous dissociations between consciousness and cognitive functions, such as attention, in humans. In addition, we describe the development of mental imagery paradigms, which made it possible to identify covert awareness in non-responsive subjects. Non-human animal consciousness research has also witnessed substantial advances on the specific role of cortical areas and higher order thalamus for consciousness, thanks to important technological enhancements. In addition, much progress has been made in the understanding of non-vertebrate cognition relevant to possible conscious states. Finally, major advances have been made in theories of consciousness, and also in their comparison with the available evidence. Along with reviewing these findings, each author suggests future avenues for research in their field of investigation. PMID:24198791

Tropisms of Avena coleoptiles: sine law for gravitropism, exponential law for photogravitropic equilibrium.

PubMed

Galland, Paul

2002-09-01

The quantitative relation between gravitropism and phototropism was analyzed for light-grown coleoptiles of Avena sativa (L.). With respect to gravitropism the coleoptiles obeyed the sine law. To study the interaction between light and gravity, coleoptiles were inclined at variable angles and irradiated for 7 h with unilateral blue light (466 nm) impinging at right angles relative to the axis of the coleoptile. The phototropic stimulus was applied from the side opposite to the direction of gravitropic bending. The fluence rate that was required to counteract the negative gravitropism increased exponentially with the sine of the inclination angle. To achieve balance, a linear increase in the gravitropic stimulus required compensation by an exponential increase in the counteracting phototropic stimulus. The establishment of photogravitropic equilibrium during continuous unilateral irradiation is thus determined by two different laws: the well-known sine law for gravitropism and a novel exponential law for phototropism described in this work.

[Common law, civil law: thinking about the tools of the judge in bioethics].

PubMed

Baudouin, Jean-Louis

2006-01-01

Civilian and common law judges differ substantially in their approach to the resolution of issues concerning bioethics and health sciences. Whereas the civilian judge will first take into account the legislative source, his common law counterpart will most probably first look at judicial precedents for guidance. In both systems, however, the legislative drafting technique differs substantially and has a direct impact on judicial interpretation of the law. Both systems also differ in the way that judicial decisions are drafted and rendered. In the common law tradition, judges draft their own opinion, leaving the possibility of dissent which, in turn, helps to better illustrate contentious issues and may have an influence on social awareness of difficult problems. Finally, in bioethics, legislation should be preferred if only for a question of social legitimacy, since decisions are then taken by elected representatives. However, this type of legislation should be subject to periodical review to better adapt its rules to the evolution of science and society.

33 CFR 88.11 - Law enforcement vessels.

Code of Federal Regulations, 2011 CFR

2011-07-01

... display a flashing blue light when engaged in direct law enforcement or public safety activities. This light must be located so that it does not interfere with the visibility of the vessel's navigation lights. (b) The blue light described in this section may be displayed by law enforcement vessels of the...

33 CFR 88.11 - Law enforcement vessels.

Code of Federal Regulations, 2014 CFR

2014-07-01

... display a flashing blue light when engaged in direct law enforcement or public safety activities. This light must be located so that it does not interfere with the visibility of the vessel's navigation lights. (b) The blue light described in this section may be displayed by law enforcement vessels of the...

33 CFR 88.11 - Law enforcement vessels.

Code of Federal Regulations, 2013 CFR

2013-07-01

... display a flashing blue light when engaged in direct law enforcement or public safety activities. This light must be located so that it does not interfere with the visibility of the vessel's navigation lights. (b) The blue light described in this section may be displayed by law enforcement vessels of the...

33 CFR 88.11 - Law enforcement vessels.

Code of Federal Regulations, 2012 CFR

2012-07-01

... display a flashing blue light when engaged in direct law enforcement or public safety activities. This light must be located so that it does not interfere with the visibility of the vessel's navigation lights. (b) The blue light described in this section may be displayed by law enforcement vessels of the...

33 CFR 88.11 - Law enforcement vessels.

Code of Federal Regulations, 2010 CFR

2010-07-01

... display a flashing blue light when engaged in direct law enforcement or public safety activities. This light must be located so that it does not interfere with the visibility of the vessel's navigation lights. (b) The blue light described in this section may be displayed by law enforcement vessels of the...

Direct and quantitative AFM measurements of the concentration and temperature dependence of the hydrophobic force law at nanoscopic contacts.

PubMed

Stock, Philipp; Utzig, Thomas; Valtiner, Markus

2015-05-15

By virtue of its importance for self-organization of biological matter the hydrophobic force law and the range of hydrophobic interactions (HI) have been debated extensively over the last 40 years. Here, we directly measure and quantify the hydrophobic force-distance law over large temperature and concentration ranges. In particular, we study the HI between molecularly smooth hydrophobic self-assembled monolayers, and similarly modified gold-coated AFM tips (radii∼8-50 nm). We present quantitative and direct evidence that the hydrophobic force is both long-ranged and exponential down to distances of about 1-2 nm. Therefore, we introduce a self-consistent radius-normalization for atomic force microscopy data. This approach allows quantitative data fitting of AFM-based experimental data to the recently proposed Hydra-model. With a statistical significance of r(2)⩾0.96 our fitting and data directly reveal an exponential HI decay length of 7.2±1.2 Å that is independent of the salt concentration up to 750 mM. As such, electrostatic screening does not have a significant influence on the HI in electrolyte concentrations ranging from 1 mM to 750 mM. In 1 M solutions the observed instability during approach shifts to longer distances, indicating ion correlation/adsorption effects at high salt concentrations. With increasing temperature the magnitude of HI decreases monotonically, while the range increases slightly. We compare our results to the large body of available literature, and shed new light into range and magnitude of hydrophobic interactions at very close distances and over wide temperature and concentration regimes. Copyright © 2015 Elsevier Inc. All rights reserved.

Robust Neighboring Optimal Guidance for the Advanced Launch System

NASA Technical Reports Server (NTRS)

Hull, David G.

1993-01-01

In recent years, optimization has become an engineering tool through the availability of numerous successful nonlinear programming codes. Optimal control problems are converted into parameter optimization (nonlinear programming) problems by assuming the control to be piecewise linear, making the unknowns the nodes or junction points of the linear control segments. Once the optimal piecewise linear control (suboptimal) control is known, a guidance law for operating near the suboptimal path is the neighboring optimal piecewise linear control (neighboring suboptimal control). Research conducted under this grant has been directed toward the investigation of neighboring suboptimal control as a guidance scheme for an advanced launch system.

Medical innovation laws: an unnecessary innovation.

PubMed

Richards, Bernadette

2016-06-01

Objective This paper aims to demonstrate that any suggestion that there is a need for specific innovation laws is flawed. Innovation is central to good medical practice and is adequately supported by current law. Methods The paper reviews the nature of medical innovation and outlines recent attempts in the UK to introduce specific laws aimed at 'encouraging' and 'supporting' innovation. The current legal framework is outlined and the role of the law in relation to medical innovation explored. Results The analysis demonstrates the cyclic relationship between medical advancement and the law and concludes that there is no requirement for specific innovation laws. Conclusions The law not only supports innovation and development in medical treatment but encourages it as central to a functioning medical system. There is no need to introduce specific laws aimed at medical innovation; to do so represents an unnecessary legal innovation and serves to complicate matters. What is known about the topic? Over recent months, there has been a great deal of discussion surrounding the law in the context of medical innovation. This was driven by the attempts in the UK to introduce specific laws in the Medical Innovation Bill. The general subject matter - negligence and the expected standard of care in the provision of treatment - is very well understood, but not in cases where the treatment can be described as innovative. The general rhetoric in both the UK and Australia around the Medical Innovation Bill demonstrates a lack of understanding of the position of the law with regards to innovative treatment. What does this paper add? This paper adds clarity to the debate. It presents the law and explains the manner in which the law can operate around innovative treatment. The paper asserts that medical innovation is both supported and encouraged by existing legal principles. What are the implications for practitioners? The paper presents an argument that can guide the policy position

[Medical Devices Law for pain therapists].

PubMed

Regner, M; Sabatowski, R

2016-08-01

Medical Devices Law is a relatively new legal system, which has replaced the Medical Devices Regulations still well-known in Germany. German Medical Devices Law is based on European directives, which are, in turn, incorporated into national law by the Medical Devices Act. The Medical Devices Act is a framework law and covers a number of regulations that address specific topics within Medical Devices Law. In turn, in individual regulations, reference is made to guidelines, recommendations, etc. from other sources that provide detailed technical information on specific topics. Medical Devices Law is a very complex legal system, which needs to be permanently observed due to constant updating and adjustment. In the current article, the design and the structure of the system will be described, but special emphasis will be laid on important problem areas that need to be considered when applying and operating medical products, in this case by pain therapists in particular.

Application of Hamilton's law of varying action

NASA Technical Reports Server (NTRS)

Bailey, C. D.

1975-01-01

The law of varying action enunciated by Hamilton in 1834-1835 permits the direct analytical solution of the problems of mechanics, both stationary and nonstationary, without consideration of force equilibrium and the theory of differential equations associated therewith. It has not been possible to obtain direct analytical solutions to nonstationary systems through the use of energy theory, which has been limited for 140 years to the principle of least action and to Hamilton's principle. It is shown here that Hamilton's law permits the direct analytical solution to nonstationary, initial value systems in the mechanics of solids without any knowledge or use of the theory of differential equations. Solutions are demonstrated for nonconservative, nonstationary particle motion, both linear and nonlinear.

What factors are associated with having an advance directive among older adults who are new to long term care services?

PubMed

Hirschman, Karen B; Abbott, Katherine M; Hanlon, Alexandra L; Prvu Bettger, Janet; Naylor, Mary D

2012-01-01

To explore differences in having an advance directive among older adults newly transitioned to long term services and support (LTSS) settings (ie, nursing homes [NHs]; assisted living facilities [ALFs]; home and community-based services). Cross sectional survey. LTSS in New York and Pennsylvania. Participants were 470 older adults who recently started receiving LTSS. Included in this analyses, N = 442 (ALF: n = 153; NH: n = 145; home and community-based services: n = 144). Interviews consisted of questions about advance directives (living will and health care power of attorney), significant health changes in the 6 months before the start of long term care support services, Mini-Mental State Examination, and basic demographics. Sixty-one percent (270/442) of older adults receiving LTSS reported having either a living will and/or an health care power of attorney. ALF residents reported having an advance directive more frequently than NH residents and older adults receiving LTSS in their own home (living will: χ(2)[2]= 120.9; P < .001; health care power of attorney: χ(2)[2]= 69.1; P < .001). In multivariate logistic regression models, receiving LTSS at an ALF (OR = 5.01; P < .001), being white (OR = 2.87; P < .001), having more than 12 years of education (OR = 2.50; P < .001), and experiencing a significant health change in past 6 months (OR = 1.97; P = .007) were predictive of having a living will. Receiving LTSS at an ALF (OR = 4.16; P < .001), having more than 12 years of education (OR = 1.74, P = .022), and having had a significant change in health in the last 6 months (OR = 1.61; P = .037) were predictive in having an health care power of attorney in this population of LTSS recipients. These data provide insight into advance directives and older adults new to LTSS. Future research is needed to better understand the barriers to completing advance directives before and during enrollment in LTSS as well as to assess advance directive completion changes over time

Ohm's law for a current sheet

NASA Technical Reports Server (NTRS)

Lyons, L. R.; Speiser, T. W.

1985-01-01

The paper derives an Ohm's law for single-particle motion in a current sheet, where the magnetic field reverses in direction across the sheet. The result is considerably different from the resistive Ohm's law often used in MHD studies of the geomagnetic tail. Single-particle analysis is extended to obtain a self-consistency relation for a current sheet which agrees with previous results. The results are applicable to the concept of reconnection in that the electric field parallel to the current is obtained for a one-dimensional current sheet with constant normal magnetic field. Dissipated energy goes directly into accelerating particles within the current sheet.

Practical and Ethical Aspects of Advance Research Directives for Research on Healthy Aging: German and Israeli Professionals' Perspectives.

PubMed

Werner, Perla; Schicktanz, Silke

2018-01-01

Healthy aging is the development and maintenance of optimal cognitive, social and physical well-being, and function in older adults. Preventing or minimizing disease is one of the main ways of achieving healthy aging. Dementia is one of the most prevalent and life-changing diseases of old age. Thus, dementia prevention research is defined as one of the main priorities worldwide. However, conducting research with persons who lack the capacity to give consent is a major ethical issue. Our study attempts to explore if and how advance research directives (ARDs) may be used as a future tool to deal with the ethical and practical issues in dementia research. We conducted focus groups and in-depth interviews with German and Israeli professional stakeholders from the fields of gerontology, ethics, medical law, psychiatry, neurology and policy advice ( n  = 16), and analyzed the main topics discussed regarding cross-national similarities and controversies within the groups, as well as across the two national contexts. While both countries are in the midst of a developmental process and have recognized the importance and need for ARD as a tool for expanding healthy aging, Germany is in a more advanced stage than Israel because of the EU regulation process, which indicates the influence of international harmonization on these research-related ethical issues. Consensual themes within the qualitative material were identified: the need for a broader debate on ARD, the ethical importance of autonomy and risk-benefit assessment for ARD implementation, the role of the proxy and the need for the differentiation of types of dementia research. Controversies and dilemmas aroused around themes such as the current role of IRBs in each country, the need for limits, and how to guaranty safeguarding and control. Implementing a new tool is a step-by-step procedure requiring a thorough understanding of the current state of knowledge as well as of the challenges and hurdles ahead. As long

Ovum donation: examining the new Israeli law.

PubMed

Gruenbaum, Benjamin F; Pinchover, Zachary S; Lunenfeld, Eitan; Jotkowitz, Alan

2011-11-01

Ovum donation affords countless couples that under natural circumstances would not be able to produce offspring the ability to carry out natural pregnancies. With advancements in biotechnology including egg collection and in vitro fertilization (IVF), physicians can now successfully implant fertilized embryos. Due to Israel's tremendous involvement in IVF for its own citizens, the national laws that govern egg donation are of great importance. On September 5th 2010, the Israeli Parliament (Knesset) passed a law that allows young women between the ages of 21 and 35 to donate their eggs for paid financial compensation. The new law allows infertile women between the ages of 18 and 54 to request egg donation and IVF, which will partially be covered under state insurance plans. This article provides a description of the new Israeli law regulating ovum donation and the practical, moral and ethical debate surrounding the new system. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

[Ethical issues in the practice of advance directives, living wills, and self-determination in end of life care].

PubMed

Fang, Hui-Feng; Jhing, Huei-Yu; Lin, Chia-Chin

2009-02-01

The Hospice-Palliative Care Act, enacted in Taiwan in 2000, was designed to respect the end of life medical wishes of patients with incurable illnesses, safeguard the rights of these patients, and provide clinical guidelines for healthcare workers responsible to provide end of life care. Self-determination is a core element of human dignity. Advance directive documents include a living will, and durable power of attorney for healthcare. This article reviews current issues and ethical dilemmas with regard to advance directives. Patients, family members, and clinicians may require better education on the Hospice-Palliative Care Act in order to respect more appropriately patient end of life medical care wishes.

The minus sign in Faraday’s law revisited

NASA Astrophysics Data System (ADS)

O'Sullivan, Colm; Hurley, Donal

2013-01-01

By introducing the mathematical concept of orientation, the significance of the minus sign in Faraday’s law may be made clear to students with some knowledge of vector calculus. For many students, however, the traditional approach of treating the law as a relationship between positive scalars and of relying on Lenz’s law to provide the information on the direction of the induced electromotive force may be a preferable pedagogical practice.

The girl child and law.

PubMed

Jain, A

1995-01-01

This article discusses the flaws in India's legislation dealing with female children and equality, marriage age, rape, adoption, child care, and inheritance. India's national policies treat children as commodities and not human beings with their own rights. The best interests of a child are not generally served in a manner that advances their welfare. Exploitation of children for labor and sexual abuse of children is widespread. Only some children have such basic needs met as education, nutrition, food, health, clothing, shelter. Children are defined by the UN as human beings below the age of 18 years. However, in India the Constitution protects only children younger than 14 in employment. The prostitution act protects children younger than 16. The juvenile justice protects girls under the age of 18 years and boys under the age of 16 years. Hindus recognize inheritance of family property only for sons. This custom contributes to the abortion of female fetuses. The practice of equal protection under the law has enough loopholes to safeguard the interests of masculine patriarchal values, norms, and structure. The Act of Marriage does not deal directly with the issue of validity and only recommends a suitable age of marriage. Women can seek divorce on the grounds she was too young to marry only if the marriage occurred before the age of 15 years. Sexual intercourse with a woman under 16 years old is rape, with or without her consent. However, in practice men receive a lesser punishment for rape if the woman is his own wife and not under 12 years of age. The rape must be reported within a year of its occurrence. India's laws penalize the adults involved in child marriages, but the Hindu Marriage Act punishes only the parties married, including the child. Marriage registration is not compulsory. India's protective laws distinguish between prostitutes and men who use prostitutes, husbands versus wives in fidelity disputes, married versus unmarried or "unchaste" women

Legal and ethical issues associated with Advance Care Directives in an Australian context.

PubMed

Denniss, D L

2016-12-01

The need for appropriate mechanisms guiding end-of-life care is increasingly vital. This commentary compares the use of Advance Care Directives (ACD) in New South Wales and South Australia in order to highlight the inconsistency in Australian legislation, before exploring common problems, legal concerns and ethical issues associated with their application in an adult population. The benefits and detriments of statutory legislation for ACD are also evaluated. © 2016 Royal Australasian College of Physicians.

A Left-Hand Rule for Faraday's Law

ERIC Educational Resources Information Center

Salu, Yehuda

2014-01-01

A left-hand rule for Faraday's law is presented here. This rule provides a simple and quick way of finding directional relationships between variables of Faraday's law without using Lenz's rule.

7 CFR 4288.104 - Compliance with other laws and regulations.

Code of Federal Regulations, 2014 CFR

2014-01-01

...-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel... biofuel producers must comply with other applicable Federal, State, and local laws, including, but not...

7 CFR 4288.104 - Compliance with other laws and regulations.

Code of Federal Regulations, 2012 CFR

2012-01-01

...-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel... biofuel producers must comply with other applicable Federal, State, and local laws, including, but not...

7 CFR 4288.104 - Compliance with other laws and regulations.

Code of Federal Regulations, 2013 CFR

2013-01-01

...-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel... biofuel producers must comply with other applicable Federal, State, and local laws, including, but not...

The significance of Bragg's law in electron diffraction and microscopy, and Bragg's second law.

PubMed

Humphreys, C J

2013-01-01

Bragg's second law, which deserves to be more widely known, is recounted. The significance of Bragg's law in electron diffraction and microscopy is then discussed, with particular emphasis on differences between X-ray and electron diffraction. As an example of such differences, the critical voltage effect in electron diffraction is described. It is then shown that the lattice imaging of crystals in high-resolution electron microscopy directly reveals the Bragg planes used for the imaging process, exactly as visualized by Bragg in his real-space law. Finally, it is shown how in 2012, for the first time, on the centennial anniversary of Bragg's law, single atoms have been identified in an electron microscope using X-rays emitted from the specimen. Hence atomic resolution X-ray maps of a crystal in real space can be formed which give the positions and identities of the different atoms in the crystal, or of a single impurity atom in the crystal.

22 CFR 72.30 - Provisions in a will or advanced directive regarding disposition of remains.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Provisions in a will or advanced directive regarding disposition of remains. 72.30 Section 72.30 Foreign Relations DEPARTMENT OF STATE PROTECTION AND WELFARE OF AMERICANS, THEIR PROPERTY AND ESTATES DEATHS AND ESTATES Real Property Overseas Belonging to A...

Comparison of China's Environmental Impact Assessment (EIA) law with the European Union (EU) EIA Directive.

PubMed

Chen, Qiaoling; Zhang, Yuanzhi; Ekroos, Ari

2007-09-01

In this paper, we first review the development of China's Environmental Impact Assessment (EIA) system in the past 30 years. Then we compare the framework and operational procedures of China's new EIA law with those of the EU EIA Directive. We also compare public participation, as well as sanctions and control in the two EIA systems. In addition, we identify where the processes in both EIA systems are similar or different from one another. By comparison, we noted that there are at least three obvious weaknesses in China's EIA system: (1) the application of new models for EIA legislation; (2) the improvement of EIA guidance and education; and (3) the enhancement of public participation in EIA process. Our study indicates that these three major shortcomings should be overcome and improved in China's EIA system, when compared with the EU EIA system.

7 CFR 1951.227 - Protective advances.

Code of Federal Regulations, 2010 CFR

2010-01-01

... in the best interest of the government. For insurance, factors such as the amount of advance... the rate specified in the most recent debt instrument authorizing such an advance. (b) Protective... securing the debt owed to or insured by FmHA or its successor agency under Public Law 103-354 if the debt...

The implementation of psychiatric advance directives: experiences from a Dutch crisis card initiative.

PubMed

van der Ham, Alida J; Voskes, Yolande; van Kempen, Nel; Broerse, Jacqueline E W; Widdershoven, Guy A M

2013-06-01

The crisis card is a specific form of psychiatric advance directive, documenting mental clients' treatment preferences in advance of a potential psychiatric crisis. In this paper, we aim to provide insight into implementation issues surrounding the crisis card. A Dutch crisis-card project formed the scope of this study. Data were collected through interviews with 15 participants from six stakeholder groups. Identified implementation issues are: (a) The role of the crisis-card counselor, (b) lack of distribution and familiarity, (c) care professionals' routines, and (d) client readiness. The crisis-card counselor appears to play a key role in fostering benefits of the crisis card by supporting clients' perspectives. More structural integration of the crisis card in care processes may enhance its impact, but should be carefully explored. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Development of ADOCS controllers and control laws. Volume 2: Literature review and preliminary analysis

NASA Technical Reports Server (NTRS)

Landis, Kenneth H.; Glusman, Steven I.

1985-01-01

The Advanced Cockpit Controls/Advanced Flight Control System (ACC/AFCS) study was conducted by the Boeing Vertol Company as part of the Army's Advanced Digital/Optical Control System (ADOCS) program. Specifically, the ACC/AFCS investigation was aimed at developing the flight control laws for the ADOCS demonstrator aircraft which will provide satisfactory handling qualities for an attack helicopter mission. The three major elements of design considered are as follows: Pilot's integrated Side-Stick Controller (SSC) -- Number of axes controlled; force/displacement characteristics; ergonomic design. Stability and Control Augmentation System (SCAS)--Digital flight control laws for the various mission phases; SCAS mode switching logic. Pilot's Displays--For night/adverse weather conditions, the dynamics of the superimposed symbology presented to the pilot in a format similar to the Advanced Attack Helicopter (AAH) Pilot Night Vision System (PNVS) for each mission phase as a function of ACAS characteristics; display mode switching logic. Findings from the literature review and the analysis and synthesis of desired control laws are reported in Volume 2. Conclusions drawn from pilot rating data and commentary were used to formulate recommendations for the ADOCS demonstrator flight control system design. The ACC/AFCS simulation data also provide an extensive data base to aid the development of advanced flight control system design for future V/STOL aircraft.

Factors affecting long-term-care residents' decision-making processes as they formulate advance directives.

PubMed

Lambert, Heather C; McColl, Mary Ann; Gilbert, Julie; Wong, Jiahui; Murray, Gale; Shortt, Samuel E D

2005-10-01

The purpose of this study was to describe factors contributing to the decision-making processes of elderly persons as they formulate advance directives in long-term care. This study was qualitative, based on grounded theory. Recruitment was purposive and continued until saturation was reached. Nine residents of a long-term-care facility were interviewed by use of a semistructured format. Open and axial coding of interview transcripts were carried out and the factors contributing to the decision process were defined. Elders based their decisions primarily on information gathered from personal experiences with death and illness. They obtained very little information from professionals or the media. Major factors considered by elders as they weighed information included spiritual, emotional, and social considerations. The factors considered during the decision-making process were oriented more toward the individual's experiences and less on contributions from objective sources than anticipated. Decision making for advance directives is a highly personalized process. The approach of health professionals when assisting with end-of-life decision making should be planned with these contributing factors in mind, so that the services offered to the individuals in this population best meet their needs.

7 CFR 766.155 - Conflict with State law.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 7 2010-01-01 2010-01-01 false Conflict with State law. 766.155 Section 766.155... AGRICULTURE SPECIAL PROGRAMS DIRECT LOAN SERVICING-SPECIAL Homestead Protection Program § 766.155 Conflict with State law. If there is a conflict between a borrower's homestead protection rights and any...

Advanced Methods for Direct Ink Write Additive Manufacturing

DOE Office of Scientific and Technical Information (OSTI.GOV)

Compel, W. S.; Lewicki, J. P.

Lawrence Livermore National Laboratory is one of the world’s premier labs for research and development of additive manufacturing processes. Out of these many processes, direct ink write (DIW) is arguably one of the most relevant for the manufacture of architected polymeric materials, components and hardware. However, a bottleneck in this pipeline that has largely been ignored to date is the lack of advanced software implementation with respect to toolpath execution. There remains to be a convenient, automated method to design and produce complex parts that is user-friendly and enabling for the realization of next generation designs and structures. For amore » material to be suitable as a DIW ink it must possess the appropriate rheological properties for this process. Most importantly, the material must exhibit shear-thinning in order to extrude through a print head and have a rapid recovery of its static shear modulus. This makes it possible for the extrudate to be self-supporting upon exiting the print head. While this and other prerequisites narrow the scope of ‘offthe- shelf’ printable materials directly amenable to DIW, the process still tolerates a wide range of potential feedstock materials. These include metallic alloys, inorganic solvent borne dispersions, polymeric melts, filler stabilized monomer compositions, pre-elastomeric feedstocks and thermoset resins each of which requires custom print conditions tailored to the individual ink. As such, an ink perfectly suited for DIW may be prematurely determined to be undesirable for the process if printed under the wrong conditions. Defining appropriate print conditions such as extrusion rate, layer height, and maximum bridge length is a vital first step in validating an ink’s DIW capability.« less

Direct and indirect effects of unilateral divorce law on marital stability.

PubMed

Kneip, Thorsten; Bauer, Gerrit; Reinhold, Steffen

2014-12-01

Previous research examining the impact of unilateral divorce law (UDL) on the prevalence of divorce has provided mixed results. Studies based on cross-sectional cross-country/cross-state survey data have received criticism for disregarding unobserved heterogeneity across countries, as have studies using country-level panel data for failing to account for possible mediating mechanisms at the micro level. We seek to overcome both shortcomings by using individual-level event-history data from 11 European countries (SHARELIFE) and controlling for unobserved heterogeneity over countries and cohorts. We find that UDL in total increased the incidence of marital breakdown by about 20 %. This finding, however, neglects potential selection effects into marriage. Accordingly, the estimated effect of unilateral divorce laws becomes much larger when we control for age at marriage, which is used as indicator for match quality. Moreover, we find that UDL particularly affects marital stability in the presence of children.

Racial and Ethnic Differences in Advance Directive Possession: Role of Demographic Factors, Religious Affiliation, and Personal Health Values in a National Survey of Older Adults

PubMed Central

Neuhaus, John M.; Chiong, Winston

2016-01-01

Abstract Background: Black and Hispanic older Americans are less likely than white older Americans to possess advance directives. Understanding the reasons for this racial and ethnic difference is necessary to identify targets for future interventions to improve advance care planning in these populations. Methods: The aim of the study was to evaluate whether racial and ethnic differences in advance directive possession are explained by other demographic factors, religious characteristics, and personal health values. A general population survey was conducted in a nationally representative sample using a web-enabled survey panel of American adults aged 50 and older (n = 2154). Results: In a sample of older Americans, white participants are significantly more likely to possess advance directives (44.0%) than black older Americans (24.0%, p < 0.001) and Hispanic older Americans (29.0%, p = 0.006). Gender, age, retired or disabled employment status, educational attainment, religious affiliation, Internet access, preferences for physician-centered decision making, and desiring longevity regardless of functional status were independent predictors of advance directive possession. In fully adjusted multivariable models with all predictors included, black older Americans remained significantly less likely than white older Americans to have an advance directive (odds ratio [OR] = 0.42, 95% confidence interval [CI] = 0.24–0.75), whereas the effect of Hispanic ethnicity was no longer statistically significant (OR = 0.65, 95% CI = 0.39–1.1). Conclusion: In a nationally representative sample, black race is an independent predictor for advance directive possession. This association remains even after adjustment for other demographic variables, religious characteristics, and personal health values. These findings support targeted efforts to mitigate racial disparities in access to advance care planning. PMID:26840850

Importance of direct patient care in advanced pharmacy practice experiences.

PubMed

Rathbun, R Chris; Hester, E Kelly; Arnold, Lindsay M; Chung, Allison M; Dunn, Steven P; Harinstein, Lisa M; Leber, Molly; Murphy, Julie A; Schonder, Kristine S; Wilhelm, Sheila M; Smilie, Kristine B

2012-04-01

The Accreditation Council for Pharmacy Education issued revised standards (Standards 2007) for professional programs leading to the Doctor of Pharmacy degree in July 2007. The new standards require colleges and schools of pharmacy to provide pharmacy practice experiences that include direct interaction with diverse patient populations. These experiences are to take place in multiple practice environments (e.g., community, ambulatory care, acute care medicine, specialized practice areas) and must include face-to-face interactions between students and patients, and students and health care providers. In 2009, the American College of Clinical Pharmacy (ACCP) identified concerns among their members that training for some students during the fourth year of pharmacy curriculums are essentially observational experiences rather than encounters where students actively participate in direct patient care activities. These ACCP members also stated that there is a need to identify effective mechanisms for preceptors to balance patient care responsibilities with students' educational needs in order to fully prepare graduates for contemporary, patient-centered practice. The 2010 ACCP Educational Affairs Committee was charged to provide recommendations to more effectively foster the integration of pharmacy students into direct patient care activities during advanced pharmacy practice experiences (APPEs). In this commentary, the benefits to key stakeholders (pharmacy students, APPE preceptors, clerkship sites, health care institutions, academic pharmacy programs) of this approach are reviewed. Recommendations for implementation of direct patient care experiences are also provided, together with discussion of the practical issues associated with delivery of effective APPE. Examples of ambulatory care and acute care APPE models that successfully integrate pharmacy students into the delivery of direct patient care are described. Enabling students to engage in high-quality patient care

Differences in Presenting Advance Directives in the Chart, in the Minimum Data Set, and through the Staffs Perceptions

ERIC Educational Resources Information Center

Cohen-Mansfield, Jiska; Libin, Alexander; Lipson, Steven

2003-01-01

Purpose: Decisions concerning end-of-life care depend on information contained in advance directives that are documented in residents' charts in the nursing home. The availability of that information depends on the quality of the chart and on the location of the information in the chart. No research was found that compared directives by the manner…

The molecular genetics of eyelid tumors: recent advances and future directions.

PubMed

Milman, Tatyana; McCormick, Steven A

2013-02-01

Unprecedented recent advances in the molecular genetics of cutaneous malignancies have markedly improved our ability to diagnose, treat, and counsel patients with skin tumors. This review provides an update on molecular genetics of periocular cutaneous basal cell carcinoma, squamous cell carcinoma, sebaceous carcinoma, Merkel cell carcinoma, and malignant melanoma and describes how the knowledge of molecular genetics is translated into clinical practice. A literature search of peer-reviewed and indexed publications from 1965 to 2012 using the PubMed search engine was performed. Key terms included: molecular genetics, eyelid, basal cell carcinoma, squamous cell carcinoma, sebaceous adenoma, sebaceous epithelioma, sebaceoma, sebaceous carcinoma, Merkel cell carcinoma, and melanoma. Seminal articles prior to 1965 were selected from primary sources and reviews from the initial search. Articles were chosen based on pertinence to clinical, genetic, and therapeutic topics reviewed in this manuscript. We reviewed the literature regarding the advances in molecular genetics of cutaneous basal cell carcinoma, squamous cell carcinoma, sebaceous neoplasia, Merkel cell carcinoma, and malignant melanoma, and possible future directions towards diagnosing and treating cutaneous tumors at the genetic level. Cell culture experiments, animal models, and molecular genetic studies on the patients' tumor tissues helped to elucidate genetic aberrations in these lesions. Cell culture experiments, animal studies and, ultimately, clinical trials provided means to test and develop novel therapeutic strategies, namely targeted therapy directed at specific molecular genetic defects. While remarkable progress has been made in this process, the complexity of the molecular genetics of skin tumors makes complete elucidation of the genetic mechanisms and the search for ideal therapies challenging. The recent studies focusing on molecular genetics of cutaneous malignancies show promising results

5 CFR 1315.16 - Relationship to other laws.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 3 2013-01-01 2013-01-01 false Relationship to other laws. 1315.16 Section 1315.16 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET OMB DIRECTIVES PROMPT PAYMENT § 1315.16 Relationship to other laws. (a) Contract Disputes Act of 1978 (41 U.S.C. 605). (1) A claim for...

5 CFR 1315.16 - Relationship to other laws.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Relationship to other laws. 1315.16 Section 1315.16 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET OMB DIRECTIVES PROMPT PAYMENT § 1315.16 Relationship to other laws. (a) Contract Disputes Act of 1978 (41 U.S.C. 605). (1) A claim for...

5 CFR 1315.16 - Relationship to other laws.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Relationship to other laws. 1315.16 Section 1315.16 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET OMB DIRECTIVES PROMPT PAYMENT § 1315.16 Relationship to other laws. (a) Contract Disputes Act of 1978 (41 U.S.C. 605). (1) A claim for...

[Animal Health Law-- the National Animal Health Act and the European Animal Health Law].

PubMed

Bätza, Hans-Joachim; Mettenleiter, Thomas

2013-01-01

The Animal Health Act that replaces the Animal Disease Act, which is currently in force, creates a regulatory framework in order to not only, as has been the case so far, control animal diseases that had already broken out, but in order to already prevent in advance possible outbreaks of animal diseases by means of preventive measures. The instruments to this effect are described here. At European level, too, the idea of prevention is set to play a greater role in the future, with the draft EU legal instrument on animal health, that has to date only been discussed at Commission level, also contributing to a simplification and easier implementation by the persons subject to law by harmonising the currently fragmented Community law. It remains to be seen when the deliberations in the Council and European Parliament will begin.

Differential effectiveness in patient protection laws: what are the causes? An example from the drive-through delivery laws.

PubMed

Dow, William H; Harris, Dean M; Liu, Zhimei

2006-12-01

In the mid-1990s, many states as well as the federal government began to regulate early postpartum hospital discharge. Length-of-stay patterns changed markedly in response, but effects were much greater in some states than others. In particular, laws directly empowering patients appeared more effective than laws requiring providers to follow practice guidelines. In addition, the effectiveness of regulation could potentially be influenced by state environment, such as managed care penetration as well as exposure to media attention and public pressure on the issue, though these factors alone were insufficient to cause general behavior change. Furthermore, the 1996 federal law had little effect beyond state laws, suggesting that it did not provide substantial benefits to women in self-insured plans exempted from state law regulation by the Employee Retirement Income Security Act. Findings from this study could provide lessons for similar patient protection initiatives.

Law of partial reform of the Organic Law of the Central Administration, 11 December 1986.

PubMed

1988-01-01

This document contains the provisions of Venezuela's 1986 Law of Partial Reform of the Organic Law of the Central Administration which sets out the activities of the newly created Ministry of the Family. The duties of the Ministry include protecting the family as a basic cell of society, protecting marriage, facilitating the acquisition of decent housing, formulating and directing state family policy, creating a General Plan for Social Development and Protection for the family, coordinating public sector programs directed towards the family, promoting the decentralization of family programs, formulating and promoting plans and programs to assist the family, advising in the creation of family-related public documents, overseeing the enforcement of legal provisions, conducting research and collecting data on family problems, promoting and executing training programs for family service personnel, and encouraging the formation of private sector programs to benefit the family.

41 CFR 302-10.301 - May I receive an advance of funds when payment is made directly to the carrier by my agency?

Code of Federal Regulations, 2010 CFR

2010-07-01

... PRIMARY RESIDENCE Advance of Funds § 302-10.301 May I receive an advance of funds when payment is made directly to the carrier by my agency? No, your agency will not authorize you an advance of funds when it... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false May I receive an advance...

Control Law for Automatic Landing Using Fuzzy-Logic Control

NASA Astrophysics Data System (ADS)

Kato, Akio; Inagaki, Yoshiki

The effectiveness of a fuzzy-logic control law for automatically landing an aircraft that handles both the control to lead an aircraft from horizontal flight at an altitude of 500 meters to flight along the glide-path course near the runway, as well as the control to direct the aircraft to land smoothly on a runway, was investigated. The control law for the automatic landing was designed to match the design goals of directing an aircraft from horizontal flight to flight along a glide-path course quickly and smoothly, and for landing smoothly on a runway. The design of the control law and evaluation of the control performance were performed considering the ground effect at landing. As a result, it was confirmed that the design goals were achieved. Even if the characteristics of the aircraft change greatly, the proposed control law is able to maintain the control performance. Moreover, it was confirmed to be able to land an aircraft safely during air turbulence. The present paper indicates that fuzzy-logic control is an effective and flexible method when applied to the control law for automatic landing, and the design method of the control law using fuzzy-logic control was obtained.

[Status of law-making on animal welfare].

PubMed

Polten, B

2007-03-01

Since the last report there have been major revisions of laws and ordinances. Deliberations on rules of Community law were also continued. On national level, the Act on the Shoeing of Horses amending the Animal Welfare Act and amendments of animal welfare provisions as well as the Deregulation Act were prepared, some of which have meanwhile entered into force. At legislative level, the work on the ratification laws for the Council of Europe conventions (Strasbourg) was concluded in order to enable Germany to adopt the revisions. They include (1) the European Convention for the protection of animals used for experimental purposes and (2) the European Convention for the protection of animals during international transport. At the level of ordinances, the amendment and extension of the Animal Welfare -Farm Animal Husbandry Ordinance are of vital importance for the sections on pig farming and laying hen husbandry. Another section refers to the husbandry of fur animals, on which an ordinance has been submitted to the Bundesrat (German upper house of Parliament). Deliberations on this issue have been adjourned. Drafts of a circus register were prepared to amend the Animal Welfare Act and to adopt a separate ordinance, and they are being discussed with the federal states and associations. Previously,the rules of Community law in the area of animal welfare were adopted as EC directives which the member states had to transfer in national law. This was done by incorporating them into national laws or ordinances, with non-compliance having to be sanctioned. It is the member states' responsibility to establish sanctions. Yet the Commission has introduced a directly operative animal welfare legislation by adopting EC Regulation 1/2005 on the protection of animals during transport. This means that a national implementation is not required. Nevertheless, the establishment of sanctions continues to be the responsibility of the member states. A special authorisation by the

Workplace compliance with a no-smoking law: a randomized community intervention trial.

PubMed Central

Rigotti, N A; Bourne, D; Rosen, A; Locke, J A; Schelling, T C

1992-01-01

BACKGROUND. Compliance with state and local laws restricting smoking in public places and workplaces has not been systematically evaluated. METHODS. We assessed workplace compliance with a comprehensive no-smoking law adopted in Brookline, Mass, and tested whether mailing information to businesses increased awareness of and compliance with the law. We conducted a random sample telephone survey of 299 businesses (87% response rate). Self-reported compliance was validated by direct observations. RESULTS. One year after its adoption, the law was popular with businesses. The prevalence of smoking restrictions, smoking policies, and no-smoking signs was 80%, 59%, and 40%, respectively. One third of businesses banned smoking. Full compliance with the law was low, however, because few businesses posted a copy of their smoking policy as required. The mailing increased employers' awareness of the law. Employers sent the mailing also reported better compliance, but this was not confirmed by direct observations. CONCLUSIONS. The law was popular and contributed to a high prevalence of workplace smoking restrictions. Different interpretations of the law by policymakers and businesses seemed to explain why formal compliance was low. The mailing increased awareness of, but not compliance with, the law. PMID:1739153

The ethical plausibility of the 'Right To Try' laws.

PubMed

Carrieri, D; Peccatori, F A; Boniolo, G

2018-02-01

'Right To Try' (RTT) laws originated in the USA to allow terminally ill patients to request access to early stage experimental medical products directly from the producer, removing the oversight and approval of the Food and Drug Administration. These laws have received significant media attention and almost equally unanimous criticism by the bioethics, clinical and scientific communities. They touch indeed on complex issues such as the conflict between individual and public interest, and the public understanding of medical research and its regulation. The increased awareness around RTT laws means that healthcare providers directly involved in the management of patients with life-threatening conditions such as cancer, infective, or neurologic conditions will deal more frequently with patients' requests of access to experimental medical products. This paper aims to assess the ethical plausibility of the RTT laws, and to suggest some possible ethical tools and considerations to address the main issues they touch. Copyright © 2017 Elsevier B.V. All rights reserved.

Advanced health biotechnologies in Thailand: redefining policy directions.

PubMed

Velasco, Román Pérez; Chaikledkaew, Usa; Myint, Chaw Yin; Khampang, Roongnapa; Tantivess, Sripen; Teerawattananon, Yot

2013-01-02

Thailand faces a significant burden in terms of treating and managing degenerative and chronic diseases. Moreover, incidences of rare diseases are rising. Many of these-such as diabetes, cancer, and inherited inborn metabolic diseases-have no definite treatments or cure. Meanwhile, advanced health biotechnology has been found, in principle, to be an effective solution for these health problems. Qualitative approaches were employed to analyse the current situation and examine existing public policies related to advanced health biotechnologies in Thailand. The results of this analysis were then used to formulate policy recommendations. Our research revealed that the system in Thailand in relation to advanced health biotechnologies is fragmented, with multiple unaddressed gaps, underfunding of research and development (R&D), and a lack of incentives for the private sector. In addition, there are no clear definitions of advanced health biotechnologies, and coverage pathways are absent. Meanwhile, false advertising and misinformation are prevalent, with no responsible bodies to actively and effectively provide appropriate information and education (I&E). The establishment of a specialised institution to fill the gaps in this area is warranted. The development and implementation of a comprehensive national strategic plan related to advanced health biotechnologies, greater investment in R&D and I&E for all stakeholders, collaboration among agencies, harmonisation of reimbursement across public health schemes, and provision of targeted I&E are specifically recommended.

Advanced health biotechnologies in Thailand: redefining policy directions

PubMed Central

2013-01-01

Background Thailand faces a significant burden in terms of treating and managing degenerative and chronic diseases. Moreover, incidences of rare diseases are rising. Many of these—such as diabetes, cancer, and inherited inborn metabolic diseases—have no definite treatments or cure. Meanwhile, advanced health biotechnology has been found, in principle, to be an effective solution for these health problems. Methods Qualitative approaches were employed to analyse the current situation and examine existing public policies related to advanced health biotechnologies in Thailand. The results of this analysis were then used to formulate policy recommendations. Results Our research revealed that the system in Thailand in relation to advanced health biotechnologies is fragmented, with multiple unaddressed gaps, underfunding of research and development (R&D), and a lack of incentives for the private sector. In addition, there are no clear definitions of advanced health biotechnologies, and coverage pathways are absent. Meanwhile, false advertising and misinformation are prevalent, with no responsible bodies to actively and effectively provide appropriate information and education (I&E). The establishment of a specialised institution to fill the gaps in this area is warranted. Conclusion The development and implementation of a comprehensive national strategic plan related to advanced health biotechnologies, greater investment in R&D and I&E for all stakeholders, collaboration among agencies, harmonisation of reimbursement across public health schemes, and provision of targeted I&E are specifically recommended. PMID:23281771

Perspectives in patent law: overview, careers, and controversies.

PubMed

Davis, Clara

2009-01-01

This paper is directed to scientists and engineers who wish to learn more about careers in patent law. It presents an overview of the patent process along with a description of the various roles of individuals and institutions involved. Finally, the paper briefly discusses a few of the more controversial issues in the patent law field today.

Relativity, nonextensivity, and extended power law distributions.

PubMed

Silva, R; Lima, J A S

2005-11-01

A proof of the relativistic theorem by including nonextensive effects is given. As it happens in the nonrelativistic limit, the molecular chaos hypothesis advanced by Boltzmann does not remain valid, and the second law of thermodynamics combined with a duality transformation implies that the parameter lies on the interval [0,2]. It is also proven that the collisional equilibrium states (null entropy source term) are described by the relativistic power law extension of the exponential Juttner distribution which reduces, in the nonrelativistic domain, to the Tsallis power law function. As a simple illustration of the basic approach, we derive the relativistic nonextensive equilibrium distribution for a dilute charged gas under the action of an electromagnetic field . Such results reduce to the standard ones in the extensive limit, thereby showing that the nonextensive entropic framework can be harmonized with the space-time ideas contained in the special relativity theory.

Genetic Psychophysiology: advances, problems, and future directions

PubMed Central

Anokhin, Andrey P.

2014-01-01

This paper presents an overview of historical advances and the current state of genetic psychophysiology, a rapidly developing interdisciplinary research linking genetics, brain, and human behavior, discusses methodological problems, and outlines future directions of research. The main goals of genetic psychophysiology are to elucidate the neural pathways and mechanisms mediating genetic influences on cognition and emotion, identify intermediate brain-based phenotypes for psychopathology, and provide a functional characterization of genes being discovered by large association studies of behavioral phenotypes. Since the initiation of this neurogenetic approach to human individual differences in the 1970s, numerous twin and family studies have provided strong evidence for heritability of diverse aspects of brain function including resting-state brain oscillations, functional connectivity, and event-related neural activity in a variety of cognitive and emotion processing tasks, as well as peripheral psychophysiological responses. These data indicate large differences in the presence and strength of genetic influences across measures and domains, permitting the selection of heritable characteristics for gene finding studies. More recently, candidate gene association studies began to implicate specific genetic variants in different aspects of neurocognition. However, great caution is needed in pursuing this line of research due to its demonstrated proneness to generate false-positive findings. Recent developments in methods for physiological signal analysis, hemodynamic imaging, and genomic technologies offer new exciting opportunities for the investigation of the interplay between genetic and environmental factors in the development of individual differences in behavior, both normal and abnormal. PMID:24739435

A qualitative analysis of an advanced practice nurse-directed transitional care model intervention.

PubMed

Bradway, Christine; Trotta, Rebecca; Bixby, M Brian; McPartland, Ellen; Wollman, M Catherine; Kapustka, Heidi; McCauley, Kathleen; Naylor, Mary D

2012-06-01

The purpose of this study was to describe barriers and facilitators to implementing a transitional care intervention for cognitively impaired older adults and their caregivers lead by advanced practice nurses (APNs). APNs implemented an evidence-based protocol to optimize transitions from hospital to home. An exploratory, qualitative directed content analysis examined 15 narrative case summaries written by APNs and fieldnotes from biweekly case conferences. Three central themes emerged: patients and caregivers having the necessary information and knowledge, care coordination, and the caregiver experience. An additional category was also identified, APNs going above and beyond. APNs implemented individualized approaches and provided care that exceeds the type of care typically staffed and reimbursed in the American health care system by applying a Transitional Care Model, advanced clinical judgment, and doing whatever was necessary to prevent negative outcomes. Reimbursement reform as well as more formalized support systems and resources are necessary for APNs to consistently provide such care to patients and their caregivers during this vulnerable time of transition.

Advance directives and living wills: the role of patient's autonomy in the Brazilian experience.

PubMed

Dantas, Eduardo

2013-12-01

This paper aims to discuss the development of the notion that the patient has the right to refuse treatment, and how the Brazilian legal system is dealing with bioethical dilemmas, such as the possibility of exercising autonomy through advance directives. The paper discusses the lack of legislation to regulate important issues in the end of life healthcare, and what ethical guidelines exist, providing physicians with ethical and legal parameters to deal with the patient's will.

Recent developments and near term directions for Navy laser weapons system (LaWS) testbed

NASA Astrophysics Data System (ADS)

Pawlak, Robert J.

2012-11-01

The Laser Weapons System (LaWS) testbed has been a demonstrator of many High Energy Laser (HEL)-related technologies for the Navy. LaWS employs a sharedaperture design with incoherent beam combining, and makes extensive use of Commercial Off-The-Shelf (COTS) technologies in the areas of inertial sensing, fiber lasers, sensors, and video trackers. Since the system has demonstrated the art of the possible with COTS elements, it is useful to examine where performance can be increased with the greatest possible effect, as well as which modifications are necessary to support better integration with ships' systems. A review of past test events, architectures, and further plans will be provided, while emphasizing the past and future evolution of the LaWS system. These evolutions will relate within the context of technical drivers that most affected system development.

Patient and caregiver characteristics related to completion of advance directives in terminally ill patients.

PubMed

Ho, Grace W K; Skaggs, Lauren; Yenokyan, Gayane; Kellogg, Anela; Johnson, Julie A; Lee, Mei Ching; Heinze, Katherine; Hughes, Mark T; Sulmasy, Daniel P; Kub, Joan; Terry, Peter B; Astrow, Alan B; Zheng, Jing; Lehmann, Lisa Soleymani; Nolan, Marie T

2017-02-01

There is a growing body of literature describing the characteristics of patients who plan for the end of life, but little research has examined how caregivers influence patients' advance care planning (ACP). The purpose of this study was to examine how patient and caregiver characteristics are associated with advance directive (AD) completion among patients diagnosed with a terminal illness. We defined AD completion as having completed a living will and/or identified a healthcare power of attorney. A convenience sample of 206 caregiver-patient dyads was included in the study. All patients were diagnosed with an advanced life-limiting illness. Trained research nurses administered surveys to collect information on patient and caregiver demographics (i.e., age, sex, race, education, marital status, and individual annual income) and patients' diagnoses and completion of AD. Multivariate logistic regression was employed to model predictors for patients' AD completion. Over half of our patient sample (59%) completed an AD. Patients who were older, diagnosed with amyotrophic lateral sclerosis, and with a caregiver who was Caucasian or declined to report an income level were more likely to have an AD in place. Our results suggest that both patient and caregiver characteristics may influence patients' decisions to complete an AD at the end of life. When possible, caregivers should be included in advance care planning for patients who are terminally ill.

Employment rights of people with diabetes: changing technology and changing law.

PubMed

Griffin, John W

2013-03-01

Though the treatment of diabetes has advanced remarkably, the law and many employers have not always kept pace. New insulins, delivery systems, and monitoring systems give people with diabetes exceptional control over their blood sugar and virtually eliminate serious complications such as hypoglycemia and hyperglycemia. Changes in the law, particularly the Americans with Disabilities Act and its 2008 amendments, give people with diabetes greater rights and employment opportunities than ever before. Despite these advances, many employers continue to use blanket bans or ill-considered standards to bar people with diabetes. Efforts to break down these remaining barriers are ongoing through employee litigation and through the American Diabetes Association's collaboration with entities that set occupational standards. © 2013 Diabetes Technology Society.

Responses of advanced directives by Jehovah’s Witnesses on a gynecologic oncology service

PubMed Central

Nagarsheth, Nimesh P; Gupta, Nikhil; Gupta, Arpeta; Moshier, Erin; Gretz, Herbert; Shander, Aryeh

2015-01-01

Objectives To review the responses of advance directives signed by Jehovah’s Witness patients prior to undergoing surgery at a gynecologic oncology service. Study design A retrospective chart review of gynecologic oncology patients undergoing surgery at a bloodless surgery center from 1998–2007 was conducted. Demographic, pathologic, and clinical data were recorded. The proportion of patients who accepted and refused various blood-derived products was determined and was compared to previously published results from a similar study of labor and delivery unit patients. Results No gynecologic oncology patients agreed to accept transfusions of whole blood, red cells, white cells, platelets, or plasma under any circumstance, whereas 9.8% of pregnant patients accepted transfusion (P=0.0385). However, 98% of gynecologic oncology patients agreed to accept some blood products, including fractions such as albumin, immunoglobulins, and clotting factors, while only 39% of pregnant patients agreed (P<0.0001). In addition, all gynecologic oncology patients (100%) accepted intraoperative hemodilution, compared to 55% of pregnant patients (P<0.0001). Conclusion Our results confirm the commonly held belief that the majority of Jehovah’s Witness patients refuse to accept major blood components. However, Jehovah’s Witness patients at a gynecologic oncology service will accept a variety of blood-derived products (minor fractions) and interventions designed to optimize outcomes when undergoing transfusion-free surgery. Patients presenting to a gynecologic oncology service respond differently to advanced directives related to bloodless surgery, as compared to patients from an obstetrical service. PMID:25565911

Public Opinion Regarding Financial Incentives to Engage in Advance Care Planning and Complete Advance Directives.

PubMed

Auriemma, Catherine L; Chen, Lucy; Olorunnisola, Michael; Delman, Aaron; Nguyen, Christina A; Cooney, Elizabeth; Gabler, Nicole B; Halpern, Scott D

2017-09-01

The Centers for Medicare & Medicaid Services (CMS) recently instituted physician reimbursements for advance care planning (ACP) discussions with patients. To measure public support for similar programs. Cross-sectional online and in-person surveys. English-speaking adults recruited at public parks in Philadelphia, Pennsylvania, from July to August 2013 and online through survey sampling international Web-based recruitment platform in July 2015. Participants indicated support for 6 programs designed to increase advance directive (AD) completion or ACP discussion using 5-point Likert scales. Participants also indicated how much money (US$0-US$1000) was appropriate to incentivize such behaviors, compared to smoking cessation or colonoscopy screening. We recruited 883 participants: 503 online and 380 in-person. The status quo of no systematic approach to motivate AD completion was supported by 67.0% of participants (63.9%-70.1%). The most popular programs were paying patients to complete ADs (58.0%; 54.5%-61.2%) and requiring patients to complete ADs or declination forms for health insurance (54.1%; 50.8%-57.4%). Participants more commonly supported paying patients to complete ADs than paying physicians whose patients complete ADs (22.6%; 19.8%-25.4%) or paying physicians who document ACP discussions (19.1%; 16.5%-21.7%; both P < .001). Participants supported smaller payments for AD completion and ACP than for obtaining screening colonoscopies or stopping smoking. Americans view payments for AD completion or ACP more skeptically than for other health behaviors and prefer that such payments go to patients rather than physicians. The current CMS policy of reimbursing physicians for ACP conversations with patients was the least preferred of the programs evaluated.

Advanced helicopter cockpit and control configurations for helicopter combat missions

NASA Technical Reports Server (NTRS)

Haworth, Loran A.; Atencio, Adolph, Jr.; Bivens, Courtland; Shively, Robert; Delgado, Daniel

1987-01-01

Two piloted simulations were conducted by the U.S. Army Aeroflightdynamics Directorate to evaluate workload and helicopter-handling qualities requirements for single pilot operation in a combat Nap-of-the-Earth environment. The single-pilot advanced cockpit engineering simulation (SPACES) investigations were performed on the NASA Ames Vertical Motion Simulator, using the Advanced Digital Optical Control System control laws and an advanced concepts glass cockpit. The first simulation (SPACES I) compared single pilot to dual crewmember operation for the same flight tasks to determine differences between dual and single ratings, and to discover which control laws enabled adequate single-pilot helicopter operation. The SPACES II simulation concentrated on single-pilot operations and use of control laws thought to be viable candidates for single pilot operations workload. Measures detected significant differences between single-pilot task segments. Control system configurations were task dependent, demonstrating a need for inflight reconfigurable control system to match the optimal control system with the required task.

Development of ADOCS controllers and control laws. Volume 1: Executive summary

NASA Technical Reports Server (NTRS)

Landis, Kenneth H.; Glusman, Steven I.

1985-01-01

The Advanced Cockpit Controls/Advanced Flight Control System (ACC/AFCS) study was conducted by the Boeing Vertol Company as part of the Army's Advanced Digital/Optical Control System (ADOCS) program. Specifically, the ACC/AFCS investigation was aimed at developing the flight control laws for the ADOCS demonstrator aircraft that will provide satisfactory handling qualities for an attack helicopter mission. The three major elements of design considered during the study are as follows: Pilot's integrated Side-Stick Controller (SSC) -- Number of axes controlled; force/displacement characteristics; ergonomic design. Stability and Control Augmentation System (SCAS)--Digital flight control laws for the various mission phases; SCAS mode switching logic. Pilot's Displays--For night/adverse weather conditions, the dynamics of the superimposed symbology presented to the pilot in a format similar to the Advanced Attack Helicopter (AAH) Pilot Night Vision System (PNVS) for each mission phase as a function of SCAS characteristics; display mode switching logic. Volume 1 is an Executive Summary of the study. Conclusions drawn from analysis of pilot rating data and commentary were used to formulate recommendations for the ADOCS demonstrator flight control system design. The ACC/AFCS simulation data also provide an extensive data base to aid the development of advanced flight control system design for future V/STOL aircraft.

Remote data entry and retrieval for law enforcement

NASA Astrophysics Data System (ADS)

Kwasowsky, Bohdan R.; Capraro, Gerard T.; Berdan, Gerald B.; Capraro, Christopher T.

1997-02-01

Law enforcement personnel need to capture and retrieve quality multimedia data in `real time' while in the field. This is not done today, for the most part. Most law enforcement officers gather data on handwritten forms and retrieve data via voice communications or fax. This approach is time consuming, costly, prone to errors, and may require months before some data are entered into a usable law enforcement database. With advances in the computing and communications industries, it is now possible to communicate with anyone using a laptop computer or personal digital assistant (PDA), given a phone line, an RF modem, or cellular capability. Many law enforcement officers have access to laptop computers within their vehicles and can stay in touch with their command center and/or retrieve data from local, state, or federal databases. However, this same capability is not available once they leave the vehicle or if the officer is on a beat, motorcycle, or horseback. This paper investigates the issues and reviews the state of the art for integrating a PDA into the gathering and retrieving of multimedia data for law enforcement.

Brazilian law for scientific use of animals.

PubMed

Marques, Ruy Garcia; Morales, Marcelo Marcos; Petroianu, Andy

2009-01-01

The Brazilian scientific community claimed for a definitive systematization and for comprehensive and realistic national rules, to provide guidance and regulation, instead of sanctions, so that the question of scientific research involving animals could be better contemplated. This is beginning to occur now with Law no. 11.794, sanctioned by the President of the Republic on November 8, 2008. To describe the evolution of Brazilian regimentation for scientific use of animals and to analyze Law no. 11.794. The legislation about the use of animals in teaching and in scientific research in Brazil and in Rio de Janeiro State was identified and discussed. Until now, there was no updated general and systematizing rule regarding animal vivisection and experimentation for didactic or scientific purposes. The only specific law dates back to 1979 and was not regimented. More recent laws equated the practice of scientific experiments to acts of abuse and mistreatment of animals, when alternative technology was available. Municipal laws that restricted the scientific practice of vivisection and experimentation with animals were created in the cities of Rio de Janeiro and Florianopolis. With the claim and collaboration of the scientific community, the sanction of Law no. 11.794 regarding the scientific use of animals represented an invaluable advance in spite of the presence of some points that eventually may require another type of treatment. The new Law states that it will be regimented within 180 (one-hundred-and-eighty) days, when some of these points could be better elucidated.

Moon Illusion and Emmert's Law.

PubMed

King, W L; Gruber, H E

1962-03-30

The perceived size of an afterimage varies with the part of the sky to which it is projected in a manner predictable from Emmert's Law and the appearance of the sky as a flattened dome. This effect is directly analogous to the moon illusion.

Zeroth Law, Entropy, Equilibrium, and All That

NASA Astrophysics Data System (ADS)

Canagaratna, Sebastian G.

2008-05-01

The place of the zeroth law in the teaching of thermodynamics is examined in the context of the recent discussion by Gislason and Craig of some problems involving the establishment of thermal equilibrium. The concept of thermal equilibrium is introduced through the zeroth law. The relation between the zeroth law and the second law in the traditional approach to thermodynamics is discussed. It is shown that the traditional approach does not need to appeal to the second law to solve with rigor the type of problems discussed by Gislason and Craig: in problems not involving chemical reaction, the zeroth law and the condition for mechanical equilibrium, complemented by the first law and any necessary equations of state, are sufficient to determine the final state. We have to invoke the second law only if we wish to calculate the change of entropy. Since most students are exposed to a traditional approach to thermodynamics, the examples of Gislason and Craig are re-examined in terms of the traditional formulation. The maximization of the entropy in the final state can be verified in the traditional approach quite directly by the use of the fundamental equations of thermodynamics. This approach uses relatively simple mathematics in as general a setting as possible.

Android-based E-Traffic law enforcement system in Surakarta City

NASA Astrophysics Data System (ADS)

Yulianto, Budi; Setiono

2018-03-01

The urban advancement is always overpowered by the increasing number of vehicles as the need for movement of people and goods. This can lead to traffic problems if there is no effort on the implementation of traffic management and engineering, and traffic law enforcement. In this case, the Government of Surakarta City has implemented various policies and regulations related to traffic management and engineering in order to run traffic in an orderly, safe and comfortable manner according to the applicable law. However, conditions in the field shows that traffic violations still occurred frequently due to the weakness of traffic law enforcement in terms of human resources and the system. In this connection, a tool is needed to support traffic law enforcement, especially in relation to the reporting system of traffic violations. This study aims to develop an Android-based traffic violations reporting application (E-Traffic Law Enforcement) as part of the traffic law enforcement system in Surakarta City. The Android-apps records the location and time of the traffic violations incident along with the visual evidence of the infringement. This information will be connected to the database system to detect offenders and to do the traffic law enforcement process.

On the application of ENO scheme with subcell resolution to conservation laws with stiff source terms

NASA Technical Reports Server (NTRS)

Chang, Shih-Hung

1991-01-01

Two approaches are used to extend the essentially non-oscillatory (ENO) schemes to treat conservation laws with stiff source terms. One approach is the application of the Strang time-splitting method. Here the basic ENO scheme and the Harten modification using subcell resolution (SR), ENO/SR scheme, are extended this way. The other approach is a direct method and a modification of the ENO/SR. Here the technique of ENO reconstruction with subcell resolution is used to locate the discontinuity within a cell and the time evolution is then accomplished by solving the differential equation along characteristics locally and advancing in the characteristic direction. This scheme is denoted ENO/SRCD (subcell resolution - characteristic direction). All the schemes are tested on the equation of LeVeque and Yee (NASA-TM-100075, 1988) modeling reacting flow problems. Numerical results show that these schemes handle this intriguing model problem very well, especially with ENO/SRCD which produces perfect resolution at the discontinuity.

[Ethics and laws related to human subject research].

PubMed

Chiu, Hui-Ju; Lee, Ya-Ling; Chang, Su-Fen

2011-10-01

Advances in medical technology rely on human subject research to test the effects on real patients of unproven new drugs, equipment and techniques. Illegal human subject research happens occasionally and has led to subject injury and medical disputes. Familiarity with the laws and established ethics related to human subject research can minimize both injury and disputes. History is a mirror that permits reflection today on past experience. Discussing the Nuremberg Code, the Declaration of Helsinki and Belmont Report, this article describes the laws, ethics, history and news related to human subject research as well as the current definition and characteristics of human subject research. Increasing numbers of nurses serve as research nurses and participate in human subject research. The authors hope this article can increase research nurse knowledge regarding laws and ethics in order to protect human research subjects adequately.

Psychiatric epidemiology: selected recent advances and future directions.

PubMed Central

Kessler, R. C.

2000-01-01

Reviewed in this article are selected recent advances and future challenges for psychiatric epidemiology. Major advances in descriptive psychiatric epidemiology in recent years include the development of reliable and valid fully structured diagnostic interviews, the implementation of parallel cross-national surveys of the prevalences and correlates of mental disorders, and the initiation of research in clinical epidemiology. Remaining challenges include the refinement of diagnostic categories and criteria, recognition and evaluation of systematic underreporting bias in surveys of mental disorders, creation and use of accurate assessment tools for studying disorders of children, adolescents, the elderly, and people in less developed countries, and setting up systems to carry out small area estimations for needs assessment and programme planning. Advances in analytical and experimental epidemiology have been more modest. A major challenge is for psychiatric epidemiologists to increase the relevance of their analytical research to their colleagues in preventative psychiatry as well as to social policy analysts. Another challenge is to develop interventions aimed at increasing the proportion of people with mental disorders who receive treatment. Despite encouraging advances, much work still needs to be conducted before psychiatric epidemiology can realize its potential to improve the mental health of populations. PMID:10885165

International developments in abortion laws: 1977-88.

PubMed Central

Cook, R J; Dickens, B M

1988-01-01

During the period between 1977 and the first quarter of 1988, 35 countries liberalized their abortion laws and four countries limited grounds for the procedure. Most legislation has extended abortion eligibility through traditional indications such as danger to maternal health or fetal handicap, but a number of other indications have been created such as adolescence, advanced maternal age, family circumstances, and AIDS or HIV infection. A number of countries have redesigned their abortion laws as part of a comprehensive package to facilitate access to and delivery of contraception, voluntary sterilization, and abortion services. Abortion litigation has increased and stimulated the liberalization of abortion provisions and the support of women's autonomous choice within the law. In Canada, the entire criminal prohibition of abortion was held unconstitutional for violating women's integrity and security. In contrast, Latin American and other constitutional developments may limit legal abortion to instances of danger to women's lives. PMID:3048126

48 CFR 18.121 - Advance payments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Law 85-804 (see Subpart 50.1, Extraordinary Contractual Actions). These advance payments may be made at or after award of sealed bid contracts, as well as negotiated contracts. (See 32.405.) [71 FR...

All in the family: law, medicine and bioethics.

PubMed

Parker, Malcolm

2008-02-01

In this first Bioethical Issues column the author outlines some of the distinctions and congruities between ethics and law, and between bioethics and medical law. The evidence for connections is obvious and wide-ranging, appearing within health and medical education, the academic literature, statute and case law, professional guidelines and the activities of professional associations, the history of legal practice and philosophical inquiry, and the emergence of human rights theory and applications. The interpenetration of morals and law is examined first by briefly tracing the development of natural law and legal positivism. These links are then developed through a number of examples which are the subjects of both bioethical and legal interest: decision-making capacity, what constitutes good medical practice in the advance care planning context, sex selection, embryo experimentation and posthumous conception. These topics illustrate some of the explicit and some of the less obvious ways in which moral considerations and medical law interact, and suggest that biolaw can involve inconsistencies and even obfuscation which, while difficult to avoid in plural societies, are appropriate areas for examination. In the final section the author argues that bioethics and medical law share some important logical features, including a prescriptivist, principled structure, which is subject to the related requirements of specification and universalisability. Again, medico-legal illustrations are used to support this proposal, which also constitutes a suitable topic for critique. Future columns will provide the opportunity for those who care about the issues of bioethics and medical law to share their thoughts and those of their colleagues.

Thinking outside the box: prenatal care and the call for a prenatal advance directive.

PubMed

Catlin, Anita

2005-01-01

The concept of advance directives is well-known in the care of adults as a mechanism for choosing in advance the extent of medical interventions desired in clinical situations, particularly life-extending interventions such as ventilation support and drugs to maintain cardiopulmonary status. Infants born extremely prematurely often require life-supporting measures for which their parents or guardians report feeling unprepared to make decisions about. Current prenatal care does not include an educational component that teaches women about the length of gestation needed for a healthy viability, survivorship, and outcome without major impairment. Women who go into preterm labor are asked to make immediate decisions during times of crisis without any formal education base for this decision making. Feminist ethics (the philosophical stance that articulates that women's moral experience is worthy of respect and disallows women's subordination) (Becker LB, Becker CB, eds. Feminist ethics. In: Encyclopedia of Ethics. New York: Routledge Press; 2001) requires that healthcare decisions be based on education, context, and particular situations. The purpose of this article is to examine the current content of typical prenatal care and education and to suggest an additional educational component to prenatal care-education of women about infant viability and the planning of future decisions if a nonviable or critically ill newborn is delivered. A prenatal discussion and parental/family directive is suggested.

29 CFR 1982.109 - Decision and orders of the administrative law judge.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 9 2013-07-01 2013-07-01 false Decision and orders of the administrative law judge. 1982... and orders of the administrative law judge. (a) The decision of the ALJ will contain appropriate... has violated the law, the order will direct the respondent to take appropriate affirmative action to...

29 CFR 1982.109 - Decision and orders of the administrative law judge.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 9 2012-07-01 2012-07-01 false Decision and orders of the administrative law judge. 1982... and orders of the administrative law judge. (a) The decision of the ALJ will contain appropriate... has violated the law, the order will direct the respondent to take appropriate affirmative action to...

29 CFR 1982.109 - Decision and orders of the administrative law judge.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 9 2011-07-01 2011-07-01 false Decision and orders of the administrative law judge. 1982... and orders of the administrative law judge. (a) The decision of the ALJ will contain appropriate... has violated the law, the order will direct the respondent to take appropriate affirmative action to...

29 CFR 1982.109 - Decision and orders of the administrative law judge.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 9 2014-07-01 2014-07-01 false Decision and orders of the administrative law judge. 1982... and orders of the administrative law judge. (a) The decision of the ALJ will contain appropriate... has violated the law, the order will direct the respondent to take appropriate affirmative action to...

Deciding in the dark: advance directives and continuation of treatment in chronic critical illness.

PubMed

Camhi, Sharon L; Mercado, Alice F; Morrison, R Sean; Du, Qingling; Platt, David M; August, Gary I; Nelson, Judith E

2009-03-01

Chronic critical illness is a devastating syndrome for which treatment offers limited clinical benefit but imposes heavy burdens on patients, families, clinicians, and the health care system. We studied the availability of advance directives and appropriate surrogates to guide decisions about life-sustaining treatment for the chronically critically ill and the extent and timing of treatment limitation. Prospective cohort study. Respiratory Care Unit (RCU) in a large, tertiary, urban, university-affiliated, hospital. Two hundred three chronically critically ill adults transferred to RCU after tracheotomy for failure to wean from mechanical ventilation in the intensive care unit. None. We interviewed RCU caregivers and reviewed patient records to identify proxy appointments, living wills, or oral statements of treatment preferences, resuscitation directives, and withholding/withdrawal of mechanical ventilation, nutrition, hydration, renal replacement and vasopressors. Forty-three of 203 patients (21.2%) appointed a proxy and 33 (16.2%) expressed preferences in advance directives. Do not resuscitate directives were given for 71 patients (35.0%). Treatment was limited for 39 patients (19.2%). Variables significantly associated with treatment limitation were proxy appointment prior to study entry (time of tracheotomy/RCU transfer) (odds ratio = 6.7, 95% confidence interval [CI], 2.3-20.0, p = 0.0006) and palliative care consultation in the RCU (OR = 40.9, 95% CI, 13.1-127.4, p < 0.0001). Median (interquartile range) time to first treatment limitation was 39 (31.0-45.0) days after hospital admission and 13 (8.0-29.0) days after RCU admission. For patients dying after treatment limitation, median time from first limitation to death ranged from 3 days for mechanical ventilation and hydration to 7 days for renal replacement. Most chronically critically ill patients fail to designate a surrogate decision-maker or express preferences regarding life-sustaining treatments

Advance directives in home health and hospice agencies: United States, 2007.

PubMed

Resnick, Helaine E; Hickman, Susan E; Foster, Gregory L

2011-11-01

This report provides nationally representative data on policies, storage, and implementation of advance directives (ADs) in home health and hospice (HHH) agencies in the United States using the National Home and Hospice Care Survey. Federally mandated ADs policies were followed in >93% of all agencies. Nearly all agencies stored ADs in a file at the agency, but only half stored them at the patient's residence. Nearly all agencies informed staff about the AD, but only 77% and 72% of home health agencies informed the attending physician and next-of-kin, respectively. Home health and hospice agencies are nearly universally compliant with ADs policies that are required in order to receive Medicare and Medicaid payments, but have much lower rates of adoption of ADs policies beyond federally mandated minimums.

Modeling and controlling a robotic convoy using guidance laws strategies.

PubMed

Belkhouche, Fethi; Belkhouche, Boumediene

2005-08-01

This paper deals with the problem of modeling and controlling a robotic convoy. Guidance laws techniques are used to provide a mathematical formulation of the problem. The guidance laws used for this purpose are the velocity pursuit, the deviated pursuit, and the proportional navigation. The velocity pursuit equations model the robot's path under various sensors based control laws. A systematic study of the tracking problem based on this technique is undertaken. These guidance laws are applied to derive decentralized control laws for the angular and linear velocities. For the angular velocity, the control law is directly derived from the guidance laws after considering the relative kinematics equations between successive robots. The second control law maintains the distance between successive robots constant by controlling the linear velocity. This control law is derived by considering the kinematics equations between successive robots under the considered guidance law. Properties of the method are discussed and proven. Simulation results confirm the validity of our approach, as well as the validity of the properties of the method. Index Terms-Guidance laws, relative kinematics equations, robotic convoy, tracking.

Conservation laws and conserved quantities for (1+1)D linearized Boussinesq equations

NASA Astrophysics Data System (ADS)

Carvalho, Cindy; Harley, Charis

2017-05-01

Conservation laws and physical conserved quantities for the (1+1)D linearized Boussinesq equations at a constant water depth are presented. These equations describe incompressible, inviscid, irrotational fluid flow in the form of a non steady solitary wave. A systematic multiplier approach is used to obtain the conservation laws of the system of third order partial differential equations (PDEs) in dimensional form. Physical conserved quantities are derived by integrating the conservation laws in the direction of wave propagation and imposing decaying boundary conditions in the horizontal direction. One of these is a newly discovered conserved quantity which relates to an energy flux density.

Engaging Patients With Advance Directives Using an Information Visualization Approach.

PubMed

Woollen, Janet; Bakken, Suzanne

2016-01-01

Despite the benefits of advance directives (AD) to patients and care providers, they are often not completed due to lack of patient awareness. The purpose of the current article is to advocate for creation and use of an innovative information visualization (infovisual) as a health communication tool aimed at improving AD dissemination and engagement. The infovisual would promote AD awareness by encouraging patients to learn about their options and inspire contemplation and conversation regarding their end-of-life (EOL) journey. An infovisual may be able to communicate insights that are often communicated in words, but are much more powerfully communicated by example. Furthermore, an infovisual could facilitate vivid understanding of options and inspire the beginning of often difficult conversations among care providers, patients, and loved ones. It may also save clinicians time, as care providers may be able to spend less time explaining details of EOL care options. Use of an infovisual could assist in ensuring a well-planned EOL journey. Copyright 2016, SLACK Incorporated.

Political factors affecting the enactment of state-level clean indoor air laws.

PubMed

Tung, Gregory Jackson; Vernick, Jon S; Stuart, Elizabeth A; Webster, Daniel W

2014-06-01

We examined the effects of key political institutional factors on the advancement of state-level clean indoor air laws. We performed an observational study of state-level clean indoor air law enactment among all 50 US states from 1993 to 2010 by using extended Cox hazard models to assess risk of enacting a relevant law. During the 18-year period from 1993 to 2010, 28 states passed a law covering workplaces, 33 states passed a law covering restaurants, 29 states passed a law covering bars, and 16 states passed a law covering gaming facilities. States with term limits had a 2.15 times greater hazard (95% confidence interval [CI] = 1.27, 3.65; P = .005) of enacting clean indoor air laws. The presence of state-level preemption of local clean indoor air laws was associated with a 3.26 times greater hazard (95% CI = 1.11, 9.53; P = .031) of state-level policy enactment. In the presence of preemption, increased legislative professionalism was strongly associated (hazard ratio = 3.28; 95% CI = 1.10, 9.75; P = .033) with clean indoor air law enactment. Political institutional factors do influence state-level clean indoor air law enactment and may be relevant to other public health policy areas.

Feedback control laws for highly maneuverable aircraft

NASA Technical Reports Server (NTRS)

Garrard, William L.; Balas, Gary J.

1994-01-01

During the first half of the year, the investigators concentrated their efforts on completing the design of control laws for the longitudinal axis of the HARV. During the second half of the year they concentrated on the synthesis of control laws for the lateral-directional axes. The longitudinal control law design efforts can be briefly summarized as follows. Longitudinal control laws were developed for the HARV using mu synthesis design techniques coupled with dynamic inversion. An inner loop dynamic inversion controller was used to simplify the system dynamics by eliminating the aerodynamic nonlinearities and inertial cross coupling. Models of the errors resulting from uncertainties in the principal longitudinal aerodynamic terms were developed and included in the model of the HARV with the inner loop dynamic inversion controller. This resulted in an inner loop transfer function model which was an integrator with the modeling errors characterized as uncertainties in gain and phase. Outer loop controllers were then designed using mu synthesis to provide robustness to these modeling errors and give desired response to pilot inputs. Both pitch rate and angle of attack command following systems were designed. The following tasks have been accomplished for the lateral-directional controllers: inner and outer loop dynamic inversion controllers have been designed; an error model based on a linearized perturbation model of the inner loop system was derived; controllers for the inner loop system have been designed, using classical techniques, that control roll rate and Dutch roll response; the inner loop dynamic inversion and classical controllers have been implemented on the six degree of freedom simulation; and lateral-directional control allocation scheme has been developed based on minimizing required control effort.

Advances and new directions in crystallization control.

PubMed

Nagy, Zoltan K; Braatz, Richard D

2012-01-01

The academic literature on and industrial practice of control of solution crystallization processes have seen major advances in the past 15 years that have been enabled by progress in in-situ real-time sensor technologies and driven primarily by needs in the pharmaceutical industry for improved and more consistent quality of drug crystals. These advances include the accurate measurement of solution concentrations and crystal characteristics as well as the first-principles modeling and robust model-based and model-free feedback control of crystal size and polymorphic identity. Research opportunities are described in model-free controller design, new crystallizer designs with enhanced control of crystal size distribution, strategies for the robust control of crystal shape, and interconnected crystallization systems for multicomponent crystallization.

[Debate over the patient's right to self-determination in Germany].

PubMed

Simon, Alfred

2008-01-01

In Germany, advanced directives ought to be regulated by law. Yet, with respect to how such a law should be set up, opinions are drifting far apart: Referring to the patient's right to self-determination, one group claims the bindingness of advanced directives. Others, by referring to physician's fiduciary duty and the state's duty to protect life, seek a limitation of bindingness of advanced directives to situations of unfavourable prognosis.

Scaling laws of coronary circulation in health and disease.

PubMed

Huo, Yunlong; Kassab, Ghassan S

2016-08-16

The heterogeneity and complexity of coronary vasculature (structure) and myocardial flow (function) have fractal-like characteristics and can be described by scaling laws with remarkable simplicity. In contrast with allometric (interspecific) scaling law, intraspecific scaling laws describe the design rules of vascular trees within a species. This paper provides an overview of intraspecific scaling laws of vascular trees and the physiological and clinical implications thereof. The significance and shortcomings of these scaling laws are discussed in relation to diffuse coronary artery disease, Glagov's positive remodeling in early stages of coronary atherosclerosis, treatment guidelines of complex bifurcation lesions, and for estimation of outlet resistance values for computation of blood flow in epicardial coronary arteries. Finally, we summarize the highlights of scaling relations and suggest some future directions. Copyright © 2016 Elsevier Ltd. All rights reserved.

The efficacy of self-directed modules for clinical learning: advanced competencies in entry-level physical therapy education.

PubMed

Peck, Kirk; Paschal, Karen; Black, Lisa; Nelson, Kelly

2014-01-01

Prior to graduation, students often express an interest to advance clinical and professional skills in teaching, research, administration, and various niche practice areas. The acquisition of advanced education in selected areas of practice is believed to improve employment opportunities, accelerate career advancement including eligibility for professional certifications, and contribute to personal satisfaction in the profession. The purpose of this paper is to (1) describe an innovative model of education, the Directed Practice Experience (DPE) elective, that incorporates a student-initiated learning process designed to achieve student-identified professional goals, and (2) report the outcomes for graduates who have completed the DPE in an entry-level program in physical therapy education. Students who met select criteria were eligible to complete a DPE. Applicants designed a 4- to 6-week clinical education experience consisting of stated rationale for personal and professional growth, examples of leadership and service, and self-directed objectives that are beyond entry-level expectations as measured by the revised Physical Therapist Clinical Performance Instrument, version 2006. Twenty-six students have completed DPEs since 2005. Fifty percent resulted in new academic partnerships. At least 25% of graduates now serve as clinical instructors for the entry-level program. Those who participated in DPEs have also completed post-graduate residencies, attained ABPTS Board certifications, authored peer-reviewed publications, and taught in both PT and residency programs. The DPE model allows qualified students to acquire advanced personal skills and knowledge prior to graduation in areas of professional practice that exceed entry-level expectations. The model is applicable to all CAPTE accredited physical therapy education programs and is especially beneficial for academic programs desiring to form new community partnerships for student clinical education.

Health information law in the context of minors.

PubMed

Rosenbaum, Sara; Abramson, Susan; MacTaggart, Patricia

2009-01-01

This article presents a legal overview of privacy and autonomy considerations related to children in the context of health information technology adoption and use. All uses of health-related technologies take place within a legal framework that guides health care generally; the privacy laws and autonomy principles long predate health information technology and can be expected to shape its design and use. Furthermore, it is a legal tenet that technology advances shape the law, and this can be expected as health information technology use evolves. Most laws related to health care, medical practice, and the right to privacy are state-based and subject to high variability. As the health information revolution increasingly eliminates the importance of geographic boundaries to health care, interstate tensions can be expected to grow. Health information privacy law is even more complex in the case of children, because the relationship between privacy law and children is itself complex. The law considers minor children to be deserving of special protection against harm and risk exposure, and this concern extends to privacy. Regardless of whether minors can shield health information from parents, it is clear that parents and children have the power to control the flow of information to and among entities. Although information protections may pose a higher standard where information about children is concerned, this fact should not overshadow the extent to which information can be used under existing legal principles. Over time, as the security and safety of information sharing are established, the law may yet evolve to permit a freer flow of information.

Timing of Advance Directive Completion and Relationship to Care Preferences.

PubMed

Enguidanos, Susan; Ailshire, Jennifer

2017-01-01

Given recent Medicare rules reimbursing clinicians for engaging in advance care planning, there is heightened need to understand factors associated with the timing of advance directive (AD) completion before death and how the timing impacts care decisions. The purpose of this study was to investigate patterns in timing of AD completion and the relationship between timing and documented care preferences. We hypothesize that ADs completed late in the course of illness or very early in the disease trajectory will reflect higher preferences for aggressive care. We conducted a retrospective study using logistic regressions to analyze data from the Health and Retirement Study, a nationally representative longitudinal survey of older adults. The analytic sample included exit interviews conducted from 2000 to 2012 among 2904 proxy reporters of deceased participants who had an AD. Nearly three-quarters (71%) of ADs were completed a year or more before death. Being younger or a racial/ethnic minority, and having lower education, a diagnosis of cancer or lung disease, and an expected death were associated with completing an AD within the three months before death, while having the lowest quartile of assets and memory problems were inversely associated with AD completion. Minorities, those with lower education, expected death, and timing of AD completion were associated with electing aggressive care. Early documentation of care wishes may not be associated with an increased likelihood of electing aggressive care; however, ADs completed in the last months of life have higher rates of election of aggressive care. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Advances in direct T-cell alloreactivity: function, avidity, biophysics and structure.

PubMed

Smith, C; Miles, J J; Khanna, R

2012-01-01

Although T-cell-based adaptive immunity plays a crucial role in protection against infectious pathogens and uncontrolled outgrowth of malignant cells, a large portion of these T cells are also capable of responding to allogeneic HLA molecules, violating the paradigm of self-major histocompatibility complex (MHC) restriction. Recent studies have provided insights into the mechanisms by which these T cells recognize allogeneic targets. The role of antiviral T cells in direct alloreactivity through peptide-dependent molecular mimicry and alternate peptide-MHC docking modes has emerged as major models for the human alloresponse. Here, we review in depth recent advances in this field and discuss how molecular interactions between T cells and HLA molecules drive the activation of these effector cells and its potential implications for alloreactivity in human transplantation. ©Copyright 2011 American Society of Transplantation and the American Society of Transplant Surgeons.

Teachers' Knowledge of Education Law

ERIC Educational Resources Information Center

Littleton, Mark

2008-01-01

The knowledge base of education-related law is growing at a rapid pace. The increase in federal and state statutes is rising commensurate with litigation that directs teachers on curricular, professional, and social matters. At the same time, numerous studies provide significant evidence that teachers lack an adequate level of knowledge of…

Administrative Law: The Hidden Comparative Law Course.

ERIC Educational Resources Information Center

Strauss, Peter L.

1996-01-01

Argues that the main contribution of the Administrative Law course to law students is that it presents problems which contrast with those of the standard court-centered curriculum and can illuminate other areas of law, repeatedly confronting students with doctrinal differences. Offers several examples from civil procedure, constitutional law, and…

Criteria for Applying the Lucas-Washburn Law.

PubMed

Li, Kewen; Zhang, Danfeng; Bian, Huiyuan; Meng, Chao; Yang, Yanan

2015-09-14

Spontaneous imbibition happens in many natural and chemical engineering processes in which the mean advancing front usually follows Lucas-Washburn's law. However it has been found that the scaling law does not apply in many cases. There have been few criteria to determine under what conditions the Washburn law works. The effect of gravity on spontaneous imbibition in porous media was investigated both theoretically and experimentally. The mathematical model derived analytically was used to calculate the imbibition rates in porous media with different permeabilities. The results demonstrated that the effect of gravity on spontaneous imbibition was governed by the hydraulic conductivity of the porous media (permeability of the imbibition systems). The criteria for applying the Lucas-Washburn law have been proposed. The effect of gravity becomes more apparent with the increase in permeability or with the decrease in CGR number (the ratio of capillary pressure to gravity forces) and may be ignored when the CGR number is less than a specific value N(*)(cg) ≅ 3.0. The effect of gravity on imbibition in porous media can be modeled theoretically. It may not be necessary to conduct spontaneous imbibition experiments horizontally in order to exclude the effect of gravity, as has been done previously.

How should Fitts' Law be applied to human-computer interaction?

NASA Technical Reports Server (NTRS)

Gillan, D. J.; Holden, K.; Adam, S.; Rudisill, M.; Magee, L.

1992-01-01

The paper challenges the notion that any Fitts' Law model can be applied generally to human-computer interaction, and proposes instead that applying Fitts' Law requires knowledge of the users' sequence of movements, direction of movement, and typical movement amplitudes as well as target sizes. Two experiments examined a text selection task with sequences of controlled movements (point-click and point-drag). For the point-click sequence, a Fitts' Law model that used the diagonal across the text object in the direction of pointing (rather than the horizontal extent of the text object) as the target size provided the best fit for the pointing time data, whereas for the point-drag sequence, a Fitts' Law model that used the vertical size of the text object as the target size gave the best fit. Dragging times were fitted well by Fitts' Law models that used either the vertical or horizontal size of the terminal character in the text object. Additional results of note were that pointing in the point-click sequence was consistently faster than in the point-drag sequence, and that pointing in either sequence was consistently faster than dragging. The discussion centres around the need to define task characteristics before applying Fitts' Law to an interface design or analysis, analyses of pointing and of dragging, and implications for interface design.

ExtLaw_H18: Extinction law code

NASA Astrophysics Data System (ADS)

Hosek, Matthew W., Jr.; Lu, Jessica R.; Anderson, Jay; Do, Tuan; Schlafly, Edward F.; Ghez, Andrea M.; Clarkson, William I.; Morris, Mark R.; Albers, Saundra M.

2018-03-01

ExtLaw_H18 generates the extinction law between 0.8 - 2.2 microns. The law is derived using the Westerlund 1 (Wd1) main sequence (A_Ks 0.6 mag) and Arches cluster field Red Clump at the Galactic Center (A_Ks 2.7 mag). To derive the law a Wd1 cluster age of 5 Myr is assumed, though changing the cluster age between 4 Myr - 7 Myr has no effect on the law. This extinction law can be applied to highly reddened stellar populations that have similar foreground material as Wd1 and the Arches RC, namely dust from the spiral arms of the Milky Way in the Galactic Plane.

Faraday's Law and Seawater Motion

ERIC Educational Resources Information Center

De Luca, R.

2010-01-01

Using Faraday's law, one can illustrate how an electromotive force generator, directly utilizing seawater motion, works. The conceptual device proposed is rather simple in its components and can be built in any high school or college laboratory. The description of the way in which the device generates an electromotive force can be instructive not…

EOS Laser Atmosphere Wind Sounder (LAWS) investigation

NASA Technical Reports Server (NTRS)

1996-01-01

In this final report, the set of tasks that evolved from the Laser Atmosphere Wind Sounder (LAWS) Science Team are reviewed, the major accomplishments are summarized, and a complete set of resulting references provided. The tasks included preparation of a plan for the LAWS Algorithm Development and Evolution Laboratory (LADEL); participation in the preparation of a joint CNES/NASA proposal to build a space-based DWL; involvement in the Global Backscatter Experiments (GLOBE); evaluation of several DWL concepts including 'Quick-LAWS', SPNDL and several direct detection technologies; and an extensive series of system trade studies and Observing System Simulation Experiments (OSSE's). In this report, some of the key accomplishments are briefly summarized with reference to interim reports, special reports, conference/workshop presentations, and publications.

Nanoscale Graphene Disk: A Natural Functionally Graded Material-How is Fourier's Law Violated along Radius Direction of 2D Disk.

PubMed

Yang, Nuo; Hu, Shiqian; Ma, Dengke; Lu, Tingyu; Li, Baowen

2015-10-07

In this Paper, we investigate numerically and analytically the thermal conductivity of nanoscale graphene disks (NGDs), and discussed the possibility to realize functionally graded material (FGM) with only one material, NGDs. Different from previous studies on divergence/non-diffusive of thermal conductivity in nano-structures with different size, we found a novel non-homogeneous (graded) thermal conductivity along the radius direction in a single nano-disk structure. We found that, instead of a constant value, the NGD has a graded thermal conductivity along the radius direction. That is, Fourier's law of heat conduction is not valid in two dimensional graphene disk structures Moreover, we show the dependent of NGDs' thermal conductivity on radius and temperature. Our study might inspire experimentalists to develop NGD based versatile FGMs, improve understanding of the heat removal of hot spots on chips, and enhance thermoelectric energy conversion efficiency by two dimensional disk with a graded thermal conductivity.

Public Health Law and Institutional Vaccine Skepticism.

PubMed

Parasidis, Efthimios

2016-12-01

Vaccine-hesitant parents are often portrayed as misinformed dilettantes clinging to unscientific Internet chatter and a debunked study that linked the MMR vaccine and autism. While this depiction may be an accurate portrayal of a small (but vocal) subset, scholars have unearthed a more complex picture that casts vaccine hesitancy in the context of broader notions of lack of trust in government and industry. At the same time, commentators have highlighted limitations of the vaccine injury compensation program and US Supreme Court Justices Sonia Sotomayor and Ruth Bader Ginsburg have argued that preemption laws that provide vaccine manufacturers with broad legal immunities create "a regulatory vacuum in which no one ensures that vaccine manufacturers adequately take account of scientific and technological advancements when designing or distributing their products." In short, the discussions surrounding vaccine hesitancy that dominate public discourse detract from serious debate as to whether amendments to vaccine-related laws can address the limitations of the existing framework governing immunizations. This commentary examines these issues through a public health law lens. Copyright © 2016 by Duke University Press.

Service, Comfort, or Emotional Support? The Evolution of Disability Law and Campus Housing

ERIC Educational Resources Information Center

Bauman, Mark; Davidson, Denise L.; Sachs, Michael C.; Kotarski, Tegan

2013-01-01

Comprehension and application of law in campus housing settings can be a daunting task. Though challenging, a basic understanding of law and how it applies to residence life and housing environments within institutions of higher education is crucial. This article provides an historical evolution of three laws that have direct bearing on campus…

A direct-execution parallel architecture for the Advanced Continuous Simulation Language (ACSL)

NASA Technical Reports Server (NTRS)

Carroll, Chester C.; Owen, Jeffrey E.

1988-01-01

A direct-execution parallel architecture for the Advanced Continuous Simulation Language (ACSL) is presented which overcomes the traditional disadvantages of simulations executed on a digital computer. The incorporation of parallel processing allows the mapping of simulations into a digital computer to be done in the same inherently parallel manner as they are currently mapped onto an analog computer. The direct-execution format maximizes the efficiency of the executed code since the need for a high level language compiler is eliminated. Resolution is greatly increased over that which is available with an analog computer without the sacrifice in execution speed normally expected with digitial computer simulations. Although this report covers all aspects of the new architecture, key emphasis is placed on the processing element configuration and the microprogramming of the ACLS constructs. The execution times for all ACLS constructs are computed using a model of a processing element based on the AMD 29000 CPU and the AMD 29027 FPU. The increase in execution speed provided by parallel processing is exemplified by comparing the derived execution times of two ACSL programs with the execution times for the same programs executed on a similar sequential architecture.

Has the sanctity of life law 'gone too far'?: analysis of the sanctity of life doctrine and English case law shows that the sanctity of life law has not 'gone too far'.

PubMed

Rabiu, Abdul-Rasheed; Sugand, Kapil

2014-02-22

The medical profession consistently strives to uphold patient empowerment, equality and safety. It is ironic that now, at a time where advances in technology and knowledge have given us an increased capacity to preserve and prolong life, we find ourselves increasingly asking questions about the value of the lives we are saving. A recent editorial by Professor Raanan Gillon questions the emphasis that English law places on the sanctity of life doctrine. In what was described by Reverend Nick Donnelly as a "manifesto for killing patients", Professor Gillon argues that the sanctity of life law has gone too far because of its disregard for distributive justice and an incompetent person's previously declared autonomy. This review begins by outlining the stance of the sanctity of life doctrine on decisions about administering, withholding and withdrawing life-prolonging treatment. Using this as a foundation for a rebuttal, a proposal is made that Professor Gillon's assertions do not take the following into account:1) A sanctity of life law does not exist since English Common Law infringes the sanctity doctrine by tolerating quality of life judgements and a doctor's intention to hasten death when withdrawing life-prolonging treatment.2) Even if a true sanctity of life law did exist:a) The sanctity of life doctrine allows for resource considerations in the wider analysis of benefits and burdens.b) The sanctity of life doctrine yields to a competent person's autonomous decision.This review attempts to demonstrate that at present, and with the legal precedent that restricts it, a sanctity of life law cannot go too far.

Does the law stymie the science? The role of law in achieving sustainable groundwater management

NASA Astrophysics Data System (ADS)

Allan, A.

2012-04-01

Legal frameworks for the management of groundwater evolved in an environment where scientific understanding of the resource was sketchy. As hydrogeological knowledge has improved over time, the law has often failed to catch up and enforcement of those laws that are in place has proved difficult. Consequently, groundwater in many countries is still managed by inadequate regimes that are unable to effectively integrate the impacts of land use management and surface water interactions. The Water Framework Directive and its associated Groundwater Directive require the integrated management of both ground and surface waters, but on a global level, this is unusual. Institutional frameworks often perpetuate this split, and the legal regime for the management of transboundary shared aquifers is a work in progress. Both national and international frameworks encourage a race to over-exploit groundwater resources. Symptomatic of the problems currently seen in groundwater management is a widespread inability to adapt to changing climate and environmental conditions. Users may be granted unchangeable rights of use in perpetuity, and the impacts of aquifer over-exploitation on dependent ecosystems may be ignored. There are therefore significant barriers to the application of existing science in many countries, and this seriously jeopardises efforts to sustainably manage groundwater. This presentation will assess current developments in the laws relating to the use of groundwater around the world, highlighting case studies from India, Australia and the USA, and assessing the implementation of the Groundwater Directive in selected European countries (in work derived from the EU-funded GENESIS project). It will also examine the legal architecture relating to international shared aquifers, and the extent to which it can cope with national groundwater use patterns that will shift in response to climate change and its consequences.

The LSU Law Center -- Canada Bijuralism Conference. Introduction: Global Law and the Law School Curriculum.

ERIC Educational Resources Information Center

Costonis, John J.

2002-01-01

Introduces papers from a conference focused on the bijural programs of Louisiana State University Law Center and McGill University Faculty of Law. The programs educate all first-degree law students in both the common law and civil law traditions, preparing them for the increasing globalization of legal practice. (EV)

Nonlinear Dynamic Inversion Baseline Control Law: Architecture and Performance Predictions

NASA Technical Reports Server (NTRS)

Miller, Christopher J.

2011-01-01

A model reference dynamic inversion control law has been developed to provide a baseline control law for research into adaptive elements and other advanced flight control law components. This controller has been implemented and tested in a hardware-in-the-loop simulation; the simulation results show excellent handling qualities throughout the limited flight envelope. A simple angular momentum formulation was chosen because it can be included in the stability proofs for many basic adaptive theories, such as model reference adaptive control. Many design choices and implementation details reflect the requirements placed on the system by the nonlinear flight environment and the desire to keep the system as basic as possible to simplify the addition of the adaptive elements. Those design choices are explained, along with their predicted impact on the handling qualities.

New Directions for NASA's Advanced Life Support Program

NASA Technical Reports Server (NTRS)

Barta, Daniel J.

2006-01-01

Exploration Life Support (ELS) Project, under the Exploration Technology Development Program, has recently been initiated to perform directed life support technology development in support of Constellation and the Crew Exploration Vehicle (CEV). ELS) has replaced ALS, with several major differences. Thermal Control Systems have been separated into a new stand alone project (Thermal Systems for Exploration Missions). Tasks in Advanced Food Technology have been relocated to the Human Research Program. Tasks in a new discipline area, Habitation Engineering, have been added. Research and technology development for capabilities required for longer duration stays on the Moon and Mars, including bioregenerative system, have been deferred.

Direct Conversion of Energy.

ERIC Educational Resources Information Center

Corliss, William R.

This publication is one of a series of information booklets for the general public published by the United States Atomic Energy Commission. Direct energy conversion involves energy transformation without moving parts. The concepts of direct and dynamic energy conversion plus the laws governing energy conversion are investigated. Among the topics…

Genetically modified plants for law enforcement applications

NASA Astrophysics Data System (ADS)

Stewart, C. Neal, Jr.

2002-08-01

Plants are ubiquitous in the environment and have the unique ability to respond to their environment physiologically and through altered gene expression profiles (they cannot walk away). In addition, plant genetic transformation techniques and genomic information in plants are becoming increasingly advanced. We have been performing research to express the jellyfish green fluorescent protein (GFP) in plants. GFP emits green light when excited by blue or UV light. In addition, my group and collaborators have developed methods to detect GFP in plants by contact instruments and at a standoff. There are several law enforcement applications for this technology. One involves using tagging and perhaps modifying drug plants genetically. In one instance, we could tag them for destruction. In another, we could adulterate them directly. Another application is one that falls into the chemical terrorism and bioterrorism countermeasures category. We are developing plants to sense toxins and whole organisms covertly. Plants are well adapted to monitor large geographic areas; biosurveillance. Some examples of research being performed focus on plants with plant pathogen inducible promoters fused to GFP for disease sensing, and algae biosensors for chemicals.

The Effects of Medical Marijuana Laws on Potency

PubMed Central

Pacula, Rosalie Liccardo; Heaton, Paul

2014-01-01

Background Marijuana potency has risen dramatically over the past two decades. In the United States, it is unclear whether state medical marijuana policies have contributed to this increase. Methods Employing a differences-in-differences model within a mediation framework, we analyzed data on n = 39,157 marijuana samples seized by law enforcement in 51 U.S. jurisdictions between 1990-2010, producing estimates of the direct and indirect effects of state medical marijuana laws on potency, as measured by Δ9-tetrahydrocannabinol content. Results We found evidence that potency increased by a half percentage point on average after legalization of medical marijuana, although this result was not significant. When we examined specific medical marijuana supply provisions, results suggest that legal allowances for retail dispensaries had the strongest influence, significantly increasing potency by about one percentage point on average. Our mediation analyses examining the mechanisms through which medical marijuana laws influence potency found no evidence of direct regulatory impact. Rather, the results suggest that the impact of these laws occurs predominantly through a compositional shift in the share of the market captured by high-potency sinsemilla. Conclusion Our findings have important implications for policymakers and those in the scientific community trying to understand the extent to which greater availability of higher potency marijuana increases the risk of negative public health outcomes, such as drugged driving and drug-induced psychoses. Future work should reconsider the impact of medical marijuana laws on health outcomes in light of dramatic and ongoing shifts in both marijuana potency and the medical marijuana policy environment. PMID:24502887

Zipf’s Law Arises Naturally When There Are Underlying, Unobserved Variables

PubMed Central

Corradi, Nicola

2016-01-01

Zipf’s law, which states that the probability of an observation is inversely proportional to its rank, has been observed in many domains. While there are models that explain Zipf’s law in each of them, those explanations are typically domain specific. Recently, methods from statistical physics were used to show that a fairly broad class of models does provide a general explanation of Zipf’s law. This explanation rests on the observation that real world data is often generated from underlying causes, known as latent variables. Those latent variables mix together multiple models that do not obey Zipf’s law, giving a model that does. Here we extend that work both theoretically and empirically. Theoretically, we provide a far simpler and more intuitive explanation of Zipf’s law, which at the same time considerably extends the class of models to which this explanation can apply. Furthermore, we also give methods for verifying whether this explanation applies to a particular dataset. Empirically, these advances allowed us extend this explanation to important classes of data, including word frequencies (the first domain in which Zipf’s law was discovered), data with variable sequence length, and multi-neuron spiking activity. PMID:27997544

A Gyroless Safehold Control Law Using Angular Momentum as an Inertial Reference Vector

NASA Technical Reports Server (NTRS)

Stoneking, Eric; Lebsock, Ken

2008-01-01

A novel safehold control law was developed for the nadir-pointing Vegetation Canopy Lidar (VCL) spacecraft, necessitated by a challenging combination of constraints. The instrument optics did not have a recloseable cover to protect them form potentially catastrophic damage if they were exposed to direct sunlight. The baseline safehold control law relied on a single-string inertial reference unit. A gyroless safehold law was developed to give a degree of robustness to gyro failures. Typical safehold solutions were not viable; thermal constraints made spin stabilization unsuitable, and an inertial hold based solely on magnetometer measurements wandered unaceptably during eclipse. The novel approach presented here maintains a momentum bias vector not for gyroscopic stiffness, but to use as an inertial reference direction during eclipse. The control law design is presented. The effect on stability of the rank-deficiency of magnetometer-based rate derivation is assessed. The control law's performance is evaluated by simulation.

A Gyroless Safehold Control Law using Angular Momentum as an Inertial Reference Vector

NASA Technical Reports Server (NTRS)

Stoneking, Eric; Lebsock, Ken

2008-01-01

A novel safehold control law was developed for the nadir-pointing Vegetation Canopy Lidar (VCL) spacecraft, necessitated by a challenging combination of constraints. The instrument optics did not have a reclosable cover to protect them from potentially catastrophic damage if they were exposed to direct sunlight. The baseline safehold control law relied on a single-string inertial reference unit. A gyroless safehold law was developed to give a degree of rebustness to gyro failures. Typical safehold solutions were not viable; thermal constraints made spin stabilization unsuitable, and an inertial hold based solely on magnetometer measurements wandered unacceptably during eclipse. The novel approach presented here maintains a momentum bias vector not for gyroscopic stiffness, but to use as an inertial reference direction during eclipse. The control law design is presented. The effect on stability of the rate-deficiency of magnetometer-based rate derivation is assessed. The control law's performance is evaluated by simulation.

Universal Power Law Governing Pedestrian Interactions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Karamouzas, Ioannis; Skinner, Brian; Guy, Stephen J.

2014-12-01

Human crowds often bear a striking resemblance to interacting particle systems, and this has prompted many researchers to describe pedestrian dynamics in terms of interaction forces and potential energies. The correct quantitative form of this interaction, however, has remained an open question. Here, we introduce a novel statistical-mechanical approach to directly measure the interaction energy between pedestrians. This analysis, when applied to a large collection of human motion data, reveals a simple power-law interaction that is based not on the physical separation between pedestrians but on their projected time to a potential future collision, and is therefore fundamentally anticipatory inmore » nature. Remarkably, this simple law is able to describe human interactions across a wide variety of situations, speeds, and densities. We further show, through simulations, that the interaction law we identify is sufficient to reproduce many known crowd phenomena.« less

Facilitation of Psychiatric Advance Directives by Peers and Clinicians on Assertive Community Treatment Teams.

PubMed

Easter, Michele M; Swanson, Jeffrey W; Robertson, Allison G; Moser, Lorna L; Swartz, Marvin S

2017-07-01

Psychiatric advance directives (PADs) provide a legal mechanism for competent adults to document care preferences and authorize a surrogate to make treatment decisions. In a controlled research setting, an evidence-based intervention, the facilitated psychiatric advance directive (FPAD), was previously shown to overcome most barriers to PAD completion. This study examined implementation of the FPAD intervention in usual care settings as delivered by peer support specialists and nonpeer clinicians on assertive community treatment (ACT) teams. A total of 145 ACT consumers were randomly assigned, within teams, to FPAD with facilitation by either a peer (N=71) or a clinician (N=74). Completion rates and PAD quality were compared with the previous study's standard and across facilitator type. Logistic regression was used to estimate effects on the likelihood of PAD completion. The completion rate of 50% in the intent-to-treat sample (N=145) was somewhat inferior to the prior standard (61%), but the rate of 58% for the retained sample (those who completed a follow-up interview, N=116) was not significantly different from the standard. Rates for peers and clinicians did not differ significantly from each other for either sample. PAD quality was similar to that achieved in the prior study. Four consumer variables predicted completion: independent living status, problematic substance use, length of time served by the ACT team, and no perceived unmet need for hospitalization in crisis. Peers and clinicians can play a crucial role in increasing the number of consumers with PADs, an important step toward improving implementation of PADs in mental health care.

An Advocacy Exercise for a Psychology and Law Course

ERIC Educational Resources Information Center

Greene, Edie

2008-01-01

This article describes an active learning component of an advanced course in psychology and law. The assignment is to present, in the context of a mock appellate court, the best available psychological data in support of one party in a legal case. Students choose one side of a hypothetical case, locate and review the relevant scientific…

Fluctuating capacity and advance decision-making in Bipolar Affective Disorder - Self-binding directives and self-determination.

PubMed

Gergel, Tania; Owen, Gareth S

2015-01-01

For people with Bipolar Affective Disorder, a self-binding (advance) directive (SBD), by which they commit themselves to treatment during future episodes of mania, even if unwilling, can seem the most rational way to deal with an imperfect predicament. Knowing that mania will almost certainly cause enormous damage to themselves, their preferred solution may well be to allow trusted others to enforce treatment and constraint, traumatic though this may be. No adequate provision exists for drafting a truly effective SBD and efforts to establish such provision are hampered by very valid, but also paralysing ethical, clinical and legal concerns. Effectively, the autonomy and rights of people with bipolar are being 'protected' through being denied an opportunity to protect themselves. From a standpoint firmly rooted in the clinical context and experience of mania, this article argues that an SBD, based on a patient-centred evaluation of capacity to make treatment decisions (DMC-T) and grounded within the clinician-patient relationship, could represent a legitimate and ethically coherent form of self-determination. After setting out background information on fluctuating capacity, mania and advance directives, this article proposes a framework for constructing such an SBD, and considers common objections, possible solutions and suggestions for future research. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Advances in Adaptive Control Methods

NASA Technical Reports Server (NTRS)

Nguyen, Nhan

2009-01-01

This poster presentation describes recent advances in adaptive control technology developed by NASA. Optimal Control Modification is a novel adaptive law that can improve performance and robustness of adaptive control systems. A new technique has been developed to provide an analytical method for computing time delay stability margin for adaptive control systems.

Harnessing the power of multimedia in offender-based law enforcement information systems

NASA Astrophysics Data System (ADS)

Zimmerman, Alan P.

1997-02-01

Criminal offenders are increasingly administratively processed by automated multimedia information systems. During this processing, case and offender biographical data, mugshot photos, fingerprints and other valuable information and media are collected by law enforcement officers. As part of their criminal investigations, law enforcement officers are routinely called to solve criminal cases based upon limited evidence . . . evidence increasingly comprised of human DNA, ballistic casings and projectiles, chemical residues, latent fingerprints, surveillance camera facial images and voices. As multimedia systems receive greater use in law enforcement, traditional approaches used to index text data are not appropriate for images and signal data which comprise a multimedia database. Multimedia systems with integrated advanced pattern matching tools will provide law enforcement the ability to effectively locate multimedia information based upon content, without reliance upon the accuracy or completeness of text-based indexing.

The Knowing-Doing Gap in Advance Directives in Asian Americans: The Role of Education and Acculturation.

PubMed

Jang, Yuri; Park, Nan Sook; Chiriboga, David A; Radhakrishnan, Kavita; Kim, Miyong T

2017-11-01

The purposes of the present study were (1) to explore the completion rate of advance directives (ADs) in a sample of Asian Americans and (2) to examine the direct and moderating effects of knowledge of AD, education, and acculturation in predicting AD completion. Education and acculturation were conceptualized as moderators in the link between knowledge and completion of ADs. Using data from 2609 participants in the 2015 Asian American Quality of Life survey (aged 18-98), logistic regression analyses on AD completion were conducted, testing both direct and moderating effects. The overall AD completion rate in sample was about 12%. The AD knowledge and acculturation independently predicted AD completion. No direct effect of education was found; however, it interacted with AD knowledge. The AD knowledge was more likely to be translated into completion in the group with higher education. The AD completion rate observed in the present sample of Asian Americans was much lower than that of the US general population (26%-36%). The interactive role of education helps to explain the gap between AD knowledge and completion and suggests intervention strategies.

Experimental confirmation of Lenz’s law

NASA Astrophysics Data System (ADS)

Mayer, V. V.; Varaksina, E. I.

2017-11-01

The paper presents a series of experiments that demonstrate the phenomenon of electromagnetic induction. These make it possible to determine the direction of the induced current and so confirm Lenz’s Law. The simple experiments can be reproduced in a school laboratory and can be recommended for students’ project activity.

WHEN TOBACCO TARGETS DIRECT DEMOCRACY

PubMed Central

Laposata, Elizabeth; Kennedy, Allison P.

2013-01-01

Tobacco control advocates began to use ballot initiatives to enact tobacco control policies in the late 1970s. In response, the tobacco industry worked for over two decades to change laws governing initiative and referendum processes to prevent passage of tobacco control measures. In 1981, the tobacco industry’s political lobbying arm, the Tobacco Institute, created a front group that presented itself as a neutral initiative research clearinghouse to affect changes in state initiative and referenda laws. In 1990, the Tobacco Institute began creating an in-house team, and worked with third party groups to try to change state initiative laws. While the industry ultimately abandoned both efforts when neither achieved immediate success, over time, the industry’s goals have penetrated legitimate discourse on the I&R process in the United States and many specific ideas it advocated have garnered mainstream support. Direct democracy advocates, as well as public health advocates and policymakers, need to understand the tobacco industry’s goals (which other industries adopted) of limiting the direct democracy process in order to ensure that any changes do not inadvertently increase the power of the special interests that direct democracy was developed to counterbalance. PMID:24603083

Legal Evidence of Subjective States: A Brain-Based Model of Chronic Pain Increases Accuracy and Fairness in Law.

PubMed

Pustilnik, Amanda C

Advances in structural and functional neuroimaging offer new ways to conceptualize chronic pain disorders and to prevent, diagnose, and treat chronic pain. Advances in pain science, though, do not entail changes in the concepts of chronic pain in law and culture. Authoritative legal and cultural conceptions of chronic pain continue to promote abstruse theories, characterizing these disorders as arising out of everything from a person's unmet need for love to resistance to "patriarchy." These constructs have consequences, impeding treatment and affecting whether individuals with chronic pain can obtain legal redress. Legal systems themselves are disadvantaged, as adjudicators struggle to make sense of regulations and presumptions at odds with the medical evidence that they must evaluate. Law's pain schema is so misdescriptive that, paradoxically, it can reward fraudulent claims and disadvantage legitimate ones. This review discusses advances in neuroimaging and related sciences that are contributing to an emerging neurological model of chronic pain. It then describes doctrines and cases in the United States and United Kingdom, demonstrating how law's pre-neurological model of pain complicates the legal process for all participants. It concludes with suggestions for doctrinal revisions, which may have broader effects on law's long-standing dualistic conception of body versus mind.

Importance of the advance directive and the beginning of the dying process from the point of view of German doctors and judges dealing with guardianship matters: results of an empirical survey.

PubMed

van Oorschot, B; Simon, A

2006-11-01

To analyse and compare the surveys on German doctors and judges on end of life decision making regarding their attitudes on the advance directive and on the dying process. The respondents were to indicate their agreement or disagreement to eight statements on the advance directive and to specify their personal view on the beginning of the dying process. 727 doctors (anaesthetists or intensive-care physicians, internal specialists and general practitioners) in three federal states and 469 judges dealing with guardianship matters all over Germany. Comparisons of means, analyses of variance, pivot tables (chi(2) test) and factor analyses (varimax with Kaiser normalisation). Three attitude groups on advance directive were disclosed by the analysis: the decision model, which emphasises the binding character of a situational advance directive; the deliberation model, which puts more emphasis on the communicative aspect; and the delegation model, which regards the advance directive as a legal instrument. The answers regarding the beginning of the dying process were broadly distributed, but no marked difference was observed between the responding professions. The dying process was assumed by most participants to begin with a life expectancy of only a few days. A high degree of valuation for advance directive was seen in both German doctors and judges; most agreed to the binding character of the situational directive. Regarding the different individual concepts of the dying process, a cross-professional discourse on the contents of this term seems to be overdue.

[Preparation and execution of advance directives and enduring powers of attorney].

PubMed

Rendenbach, Ulrich

2008-01-01

If a person wants to preclude other people making decisions on his/her behalf, this needs to be recorded in a legally relevant form by means of a declaration of intent. For example, the latter could be a contract (nursing home contract) or an advance directive. The circumstances under which a declaration becomes effective have to be exactly and carefully worded. Also, it has to be accurately defined who is to enforce the declaration of intent against defiance and in which situation. Physicians, lawyers, nursing staff, politicians, members of ethics committees, sponsors, relatives--everyone may have a different opinion, and the patient's well-being might easily be ignored. A legal regulation will contribute little to safety at the end of life. The responsibility lies with the physician. The legislator cannot guide the physician's therapeutic decisions, but an invalid patient can who has expressed his desire to die and unmistakably advised his physician on when to refrain from which procedures.

Systematic harmonic power laws inter-relating multiple fundamental constants

NASA Astrophysics Data System (ADS)

Chakeres, Donald; Buckhanan, Wayne; Andrianarijaona, Vola

2017-01-01

Power laws and harmonic systems are ubiquitous in physics. We hypothesize that 2, π, the electron, Bohr radius, Rydberg constant, neutron, fine structure constant, Higgs boson, top quark, kaons, pions, muon, Tau, W, and Z when scaled in a common single unit are all inter-related by systematic harmonic powers laws. This implies that if the power law is known it is possible to derive a fundamental constant's scale in the absence of any direct experimental data of that constant. This is true for the case of the hydrogen constants. We created a power law search engine computer program that randomly generated possible positive or negative powers searching when the product of logical groups of constants equals 1, confirming they are physically valid. For 2, π, and the hydrogen constants the search engine found Planck's constant, Coulomb's energy law, and the kinetic energy law. The product of ratios defined by two constants each was the standard general format. The search engine found systematic resonant power laws based on partial harmonic fraction powers of the neutron for all of the constants with products near 1, within their known experimental precision, when utilized with appropriate hydrogen constants. We conclude that multiple fundamental constants are inter-related within a harmonic power law system.

Do neural nets learn statistical laws behind natural language?

PubMed

Takahashi, Shuntaro; Tanaka-Ishii, Kumiko

2017-01-01

The performance of deep learning in natural language processing has been spectacular, but the reasons for this success remain unclear because of the inherent complexity of deep learning. This paper provides empirical evidence of its effectiveness and of a limitation of neural networks for language engineering. Precisely, we demonstrate that a neural language model based on long short-term memory (LSTM) effectively reproduces Zipf's law and Heaps' law, two representative statistical properties underlying natural language. We discuss the quality of reproducibility and the emergence of Zipf's law and Heaps' law as training progresses. We also point out that the neural language model has a limitation in reproducing long-range correlation, another statistical property of natural language. This understanding could provide a direction for improving the architectures of neural networks.

Do neural nets learn statistical laws behind natural language?

PubMed Central

Takahashi, Shuntaro

2017-01-01

The performance of deep learning in natural language processing has been spectacular, but the reasons for this success remain unclear because of the inherent complexity of deep learning. This paper provides empirical evidence of its effectiveness and of a limitation of neural networks for language engineering. Precisely, we demonstrate that a neural language model based on long short-term memory (LSTM) effectively reproduces Zipf’s law and Heaps’ law, two representative statistical properties underlying natural language. We discuss the quality of reproducibility and the emergence of Zipf’s law and Heaps’ law as training progresses. We also point out that the neural language model has a limitation in reproducing long-range correlation, another statistical property of natural language. This understanding could provide a direction for improving the architectures of neural networks. PMID:29287076

Health care law versus constitutional law.

PubMed

Hall, Mark A

2013-04-01

National Federation of Independent Business v. Sebelius, the Supreme Court's ruling on the Patient Protection and Affordable Care Act, is a landmark decision - both for constitutional law and for health care law and policy. Others will study its implications for constitutional limits on a range of federal powers beyond health care. This article considers to what extent the decision is also about health care law, properly conceived. Under one view, health care law is the subdiscipline that inquires how courts and government actors take account of the special features of medicine that make legal or policy issues especially problematic - rather than regarding health care delivery and finance more generically, like most any other economic or social enterprise. Viewed this way, the opinions from the Court's conservative justices are mainly about general constitutional law principles. In contrast, Justice Ruth Bader Ginsburg's dissenting opinion for the four more liberal justices is just as much about health care law as it is about constitutional law. Her opinion gives detailed attention to the unique features of health care finance and delivery in order to inform her analysis of constitutional precedents and principles. Thus, the Court's multiple opinions give a vivid depiction of the compelling contrasts between communal versus individualistic conceptions of caring for those in need, and between health care and health insurance as ordinary commodities versus ones that merit special economic, social, and legal status.

Pediatric advance directives: parents' knowledge, experience, and preferences.

PubMed

Liberman, Danica B; Pham, Phung K; Nager, Alan L

2014-08-01

To explore parents' and caregivers' experience, knowledge, and preferences regarding advance directives (ADs) for children who have chronic illness. We conducted a prospective, cross-sectional survey of parents and caregivers of children who have chronic illness. During ambulatory medical visits, participants were asked about previous AD experience and knowledge, future preferences regarding AD discussions, their child's past and current health status, and family demographics. Among 307 participants surveyed, previous AD experience was low, with 117 (38.1%) having heard of an AD, 54 (17.6%) having discussed one, and 77 (25.1%) having known someone who had an AD. Furthermore, 27 (8.8%) participants had an AD or living will of their own, and 8 (2.6%) reported that their chronically ill child had an AD. Previous AD knowledge was significantly more likely among parents and caregivers who had a college degree than those who did not have a high school diploma, yet significantly less likely among primarily Spanish-speaking parents and caregivers than those primarily English-speaking. Interest in creating an AD for the child was reported by 151 (49.2%) participants, and was significantly more likely among families who had more frequent emergency department visits over the previous year. The limited AD experience and knowledge of parents and caregivers of children who have chronic illness and their interest in creating an AD suggest an unmet need among families of children who have chronic illness, and an opportunity to enhance communication between families and medical teams regarding ADs and end-of-life care. Copyright © 2014 by the American Academy of Pediatrics.

Reproduction, genetics and the law.

PubMed

Crockin, Susan L

2005-06-01

Both reproductive medicine and genetics are seeing rapid, and in some instances revolutionary, medical and scientific advances. Courts have been called upon to resolve a variety of novel disputes arising from these areas, and more can be anticipated as these technologies continue to develop and their use becomes more widespread. This article discusses some of the most relevant areas of the law and litigation that currently bear on reproduction and genetics or that may be anticipated to do so in the future. Specific developments and judicial decisions addressing them include: legal theories of wrongful birth and wrongful life and their application to children born with genetic impairments; a physician's duty to warn family members about a relative's genetic disease; disputes over reproductive materials and non-reproductive cells and tissues; unauthorized genetic testing in the workplace; and genetic discrimination. It is hoped that this discussion will be of value to medical and legal professionals and policy makers who work with these concepts in the increasingly inter-related fields of law and medicine.

Origin of Noncubic Scaling Law in Disordered Granular Packing.

PubMed

Xia, Chengjie; Li, Jindong; Kou, Binquan; Cao, Yixin; Li, Zhifeng; Xiao, Xianghui; Fu, Yanan; Xiao, Tiqiao; Hong, Liang; Zhang, Jie; Kob, Walter; Wang, Yujie

2017-06-09

Recent diffraction experiments on metallic glasses have unveiled an unexpected noncubic scaling law between density and average interatomic distance, which led to the speculation of the presence of fractal glass order. Using x-ray tomography we identify here a similar noncubic scaling law in disordered granular packing of spherical particles. We find that the scaling law is directly related to the contact neighbors within the first nearest neighbor shell, and, therefore, is closely connected to the phenomenon of jamming. The seemingly universal scaling exponent around 2.5 arises due to the isostatic condition with a contact number around 6, and we argue that the exponent should not be universal.

Nanoscale Graphene Disk: A Natural Functionally Graded Material–How is Fourier’s Law Violated along Radius Direction of 2D Disk

PubMed Central

Yang, Nuo; Hu, Shiqian; Ma, Dengke; Lu, Tingyu; Li, Baowen

2015-01-01

In this Paper, we investigate numerically and analytically the thermal conductivity of nanoscale graphene disks (NGDs), and discussed the possibility to realize functionally graded material (FGM) with only one material, NGDs. Different from previous studies on divergence/non-diffusive of thermal conductivity in nano-structures with different size, we found a novel non-homogeneous (graded) thermal conductivity along the radius direction in a single nano-disk structure. We found that, instead of a constant value, the NGD has a graded thermal conductivity along the radius direction. That is, Fourier’s law of heat conduction is not valid in two dimensional graphene disk structures Moreover, we show the dependent of NGDs’ thermal conductivity on radius and temperature. Our study might inspire experimentalists to develop NGD based versatile FGMs, improve understanding of the heat removal of hot spots on chips, and enhance thermoelectric energy conversion efficiency by two dimensional disk with a graded thermal conductivity. PMID:26443206

Weiqi games as a tree: Zipf's law of openings and beyond

NASA Astrophysics Data System (ADS)

Xu, Li-Gong; Li, Ming-Xia; Zhou, Wei-Xing

2015-06-01

Weiqi is one of the most complex board games played by two persons. The placement strategies adopted by Weiqi players are often used to analog the philosophy of human wars. Contrary to the western chess, Weiqi games are less studied by academics partially because Weiqi is popular only in East Asia, especially in China, Japan and Korea. Here, we propose to construct a directed tree using a database of extensive Weiqi games and perform a quantitative analysis of the Weiqi tree. We find that the popularity distribution of Weiqi openings with the same number of moves is distributed according to a power law and the tail exponent increases with the number of moves. Intriguingly, the superposition of the popularity distributions of Weiqi openings with a number of moves not higher than a given number also has a power-law tail in which the tail exponent increases with the number of moves, and the superposed distribution approaches the Zipf law. These findings are the same as for chess and support the conjecture that the popularity distribution of board game openings follows the Zipf law with a universal exponent. We also find that the distribution of out-degrees has a power-law form, the distribution of branching ratios has a very complicated pattern, and the distribution of uniqueness scores defined by the path lengths from the root vertex to the leaf vertices exhibits a unimodal shape. Our work provides a promising direction for the study of the decision-making process of Weiqi playing from the perspective of directed branching tree.

Development of ADOCS controllers and control laws. Volume 3: Simulation results and recommendations

NASA Technical Reports Server (NTRS)

Landis, Kenneth H.; Glusman, Steven I.

1985-01-01

The Advanced Cockpit Controls/Advanced Flight Control System (ACC/AFCS) study was conducted by the Boeing Vertol Company as part of the Army's Advanced Digital/Optical Control System (ADOCS) program. Specifically, the ACC/AFCS investigation was aimed at developing the flight control laws for the ADOCS demonstator aircraft which will provide satisfactory handling qualities for an attack helicopter mission. The three major elements of design considered are as follows: Pilot's integrated Side-Stick Controller (SSC) -- Number of axes controlled; force/displacement characteristics; ergonomic design. Stability and Control Augmentation System (SCAS)--Digital flight control laws for the various mission phases; SCAS mode switching logic. Pilot's Displays--For night/adverse weather conditions, the dynamics of the superimposed symbology presented to the pilot in a format similar to the Advanced Attack Helicopter (AAH) Pilot Night Vision System (PNVS) for each mission phase is a function of SCAS characteristics; display mode switching logic. Results of the five piloted simulations conducted at the Boeing Vertol and NASA-Ames simulation facilities are presented in Volume 3. Conclusions drawn from analysis of pilot rating data and commentary were used to formulate recommendations for the ADOCS demonstrator flight control system design. The ACC/AFCS simulation data also provide an extensive data base to aid the development of advanced flight control system design for future V/STOL aircraft.

Direct Loans: A Better Way To Borrow. William D. Ford Federal Direct Loan Program.

ERIC Educational Resources Information Center

Department of Education, Washington, DC. Student Financial Assistance.

The Web site http://www.ed.gov/DirectLoan/ provides information on the William D. Ford Federal Direct Loan Program for both professionals and borrowers. For professionals, it provides information on conferences, promissory notes, regulations, laws, and relevant links, as well as technical assistance, and other publications and guides. For…

LAWS (Laser Atmospheric Wind Sounder) earth observing system

NASA Technical Reports Server (NTRS)

1988-01-01

Wind profiles can be measured from space using current technology. These wind profiles are essential for answering many of the interdisciplinary scientific questions to be addressed by EOS, the Earth Observing System. This report provides guidance for the development of a spaceborne wind sounder, the Laser Atmospheric Wind Sounder (LAWS), discussing the current state of the technology and reviewing the scientific rationale for the instrument. Whether obtained globally from the EOS polar platform or in the tropics and subtropics from the Space Station, wind profiles from space will provide essential information for advancing the skill of numerical weather prediction, furthering knowledge of large-scale atmospheric circulation and climate dynamics, and improving understanding of the global biogeochemical and hydrologic cycles. The LAWS Instrument Panel recommends that it be given high priority for new instrument development because of the pressing scientific need and the availability of the necessary technology. LAWS is to measure wind profiles with an accuracy of a few meters per second and to sample at intervals of 100 km horizontally for layers km thick.

Diversity of individual mobility patterns and emergence of aggregated scaling laws

PubMed Central

Yan, Xiao-Yong; Han, Xiao-Pu; Wang, Bing-Hong; Zhou, Tao

2013-01-01

Uncovering human mobility patterns is of fundamental importance to the understanding of epidemic spreading, urban transportation and other socioeconomic dynamics embodying spatiality and human travel. According to the direct travel diaries of volunteers, we show the absence of scaling properties in the displacement distribution at the individual level,while the aggregated displacement distribution follows a power law with an exponential cutoff. Given the constraint on total travelling cost, this aggregated scaling law can be analytically predicted by the mixture nature of human travel under the principle of maximum entropy. A direct corollary of such theory is that the displacement distribution of a single mode of transportation should follow an exponential law, which also gets supportive evidences in known data. We thus conclude that the travelling cost shapes the displacement distribution at the aggregated level. PMID:24045416

Medicare and Advance Planning: The Importance of Context.

PubMed

Dresser, Rebecca

2016-05-01

In January 2016, a long-delayed Medicare change took effect. The Medicare program will now reimburse doctors for time they spend talking with patients about end-of-life care. This is the move that Sarah Palin and other Affordable Care Act critics said would authorize government "death panels" to decide whether older Americans should live or die. Today virtually no one buys into Palin's death panel rhetoric. But many people do think the Medicare change is a big deal. Representative Earl Blumenauer, a Democrat from Oregon who sponsored the original ACA reimbursement proposal, lauded the Medicare provision as "a turning point in end-of-life care." Others are not so sure about that. After all, laws promoting advance care planning have existed for decades. The federal Patient Self-Determination Act of 1990 and the many court decisions and state laws supporting advance care planning have had relatively little impact. Similarly, legal recognition of physician orders for life-sustaining treatment as advance planning instruments have not produced the improvements that were predicted. And from a broad perspective, advance care planning is a small piece of the puzzle. The effort to improve end-of-life care must take into account the limitations of advance decision-making, as well as the overriding importance of the general standard of care for terminally ill patients. © 2016 The Hastings Center.

Law No. 8 of 1988.

PubMed

1988-01-01

This document contains major provisions of Iraq's 1988 law dealing with prostitution. Prison terms are set for pimps and proprietors of establishments used for prostitution. The terms are more severe for those who keep prostitutes under the age of 18. In addition, the Ministry of Labor and Social Affairs is directed to prepare homes where male and female prostitutes can be placed in reformatory detention.

A growth model for directed complex networks with power-law shape in the out-degree distribution

PubMed Central

Esquivel-Gómez, J.; Stevens-Navarro, E.; Pineda-Rico, U.; Acosta-Elias, J.

2015-01-01

Many growth models have been published to model the behavior of real complex networks. These models are able to reproduce several of the topological properties of such networks. However, in most of these growth models, the number of outgoing links (i.e., out-degree) of nodes added to the network is constant, that is all nodes in the network are born with the same number of outgoing links. In other models, the resultant out-degree distribution decays as a poisson or an exponential distribution. However, it has been found that in real complex networks, the out-degree distribution decays as a power-law. In order to obtain out-degree distribution with power-law behavior some models have been proposed. This work introduces a new model that allows to obtain out-degree distributions that decay as a power-law with an exponent in the range from 0 to 1. PMID:25567141

The Impact of State Laws Limiting Malpractice Damage Awards on Health Care Expenditures

PubMed Central

Hellinger, Fred J.; Encinosa, William E.

2006-01-01

Twenty-eight states have laws that limit payments in malpractice cases, and several studies indicate that these laws reduce the frequency and severity of malpractice claims and lower premiums. Moreover, proponents believe that such laws reduce health care expenditures by reducing the practice of defensive medicine. However, there is a dearth of empirical evidence about the impact of these laws on the cost of health care. We used multivariate models and relatively recent data to estimate the impact of state tort reform laws that directly limit malpractice damage payments on health care expenditures. Estimates from these models suggest that laws limiting malpractice payments lower state health care expenditures by between 3% and 4%. PMID:16809580

Processing of alnico permanent magnets by advanced directional solidification methods

DOE PAGES

Zou, Min; Johnson, Francis; Zhang, Wanming; ...

2016-07-05

Advanced directional solidification methods have been used to produce large (>15 cm length) castings of Alnico permanent magnets with highly oriented columnar microstructures. In combination with subsequent thermomagnetic and draw thermal treatment, this method was used to enable the high coercivity, high-Titanium Alnico composition of 39% Co, 29.5% Fe, 14% Ni, 7.5% Ti, 7% Al, 3% Cu (wt%) to have an intrinsic coercivity (H ci) of 2.0 kOe, a remanence (B r) of 10.2 kG, and an energy product (BH) max of 10.9 MGOe. These properties compare favorably to typical properties for the commercial Alnico 9. Directional solidification of highermore » Ti compositions yielded anisotropic columnar grained microstructures if high heat extraction rates through the mold surface of at least 200 kW/m 2 were attained. This was achieved through the use of a thin walled (5 mm thick) high thermal conductivity SiC shell mold extracted from a molten Sn bath at a withdrawal rate of at least 200 mm/h. However, higher Ti compositions did not result in further increases in magnet performance. Images of the microstructures collected by scanning electron microscopy (SEM) reveal a majority α phase with inclusions of secondary αγ phase. Transmission electron microscopy (TEM) reveals that the α phase has a spinodally decomposed microstructure of FeCo-rich needles in a NiAl-rich matrix. In the 7.5% Ti composition the diameter distribution of the FeCo needles was bimodal with the majority having diameters of approximately 50 nm with a small fraction having diameters of approximately 10 nm. The needles formed a mosaic pattern and were elongated along one <001> crystal direction (parallel to the field used during magnetic annealing). Cu precipitates were observed between the needles. Regions of abnormal spinodal morphology appeared to correlate with secondary phase precipitates. The presence of these abnormalities did not prevent the material from displaying superior magnetic properties in the 7

Application of Hamilton's Law of Varying Action

NASA Technical Reports Server (NTRS)

Bailey, C. D.

1973-01-01

The application of Hamilton's Law to the direct solution of nonstationary as well as stationary problems in mechanics of solids is discussed. Solutions are demonstrated for conservative and monconservative, stationary and/or nonstationary particle motion. Mathematical models are developed to establish the relationships of the parameters.

Observation of the Dirac fluid and the breakdown of the Wiedemann-Franz law in graphene.

PubMed

Crossno, Jesse; Shi, Jing K; Wang, Ke; Liu, Xiaomeng; Harzheim, Achim; Lucas, Andrew; Sachdev, Subir; Kim, Philip; Taniguchi, Takashi; Watanabe, Kenji; Ohki, Thomas A; Fong, Kin Chung

2016-03-04

Interactions between particles in quantum many-body systems can lead to collective behavior described by hydrodynamics. One such system is the electron-hole plasma in graphene near the charge-neutrality point, which can form a strongly coupled Dirac fluid. This charge-neutral plasma of quasi-relativistic fermions is expected to exhibit a substantial enhancement of the thermal conductivity, thanks to decoupling of charge and heat currents within hydrodynamics. Employing high-sensitivity Johnson noise thermometry, we report an order of magnitude increase in the thermal conductivity and the breakdown of the Wiedemann-Franz law in the thermally populated charge-neutral plasma in graphene. This result is a signature of the Dirac fluid and constitutes direct evidence of collective motion in a quantum electronic fluid. Copyright © 2016, American Association for the Advancement of Science.

Darwin's laws.

PubMed

Haufe, Chris

2012-03-01

There is widespread agreement among contemporary philosophers of biology and philosophically-minded biologists that Darwin's insights about the intrusion of chance processes into biological regularities undermines the possibility of there being biological laws. Darwin made references to "designed laws." He also freely described some laws as having exceptions. This paper provides a philosophical analysis of the notion of scientific laws that was dominant in Darwin's time, and in all probability the one which he inherited. The analysis of laws is then used to show how it could have been natural for Darwin to believe in designed laws that had exceptions, and to highlight the continuity between the metaphysics of pre-Darwinian, Darwinian, and contemporary biological science. One important result is the removal of one motivation for the anti-laws sentiment in philosophy and biology. Copyright © 2011 Elsevier Ltd. All rights reserved.

Power Law Distributions of Patents as Indicators of Innovation

NASA Astrophysics Data System (ADS)

O'Neale, Dion; Hendy, Shaun

2013-03-01

The total number of patents produced by a country (or the number of patents produced per capita) is often used as an indicator for innovation. Such figures however give an overly simplistic measure of innovation within a country. Here we present evidence that the distribution of patents amongst applicants within many countries is well-fitted to a power law distribution with exponents that vary between 1.66 (Japan) and 2.37 (Poland). We suggest that this exponent is a useful new metric for studying innovation. Using simulations based on simple preferential attachment-type rules that generate power laws, we find we can explain some of the variation in exponents between countries, with countries that have larger numbers of patents per applicant generally exhibiting smaller exponents in both the simulated and actual data. Similarly we find that the exponents for most countries are inversely correlated with other indicators of innovation, such as research and development intensity or the ubiquity of export baskets. This suggests that in more advanced economies, which tend to have smaller values of the exponent, a greater proportion of the total number of patents are filed by large companies than in less advanced countries.

Similarity law and critical properties in ionic systems.

NASA Astrophysics Data System (ADS)

Desgranges, Caroline; Delhommelle, Jerome

2017-11-01

Using molecular simulations, we determine the locus of ideal compressibility, or Zeno line, for a series of ionic compounds. We find that the shape of this thermodynamic contour follows a linear law, leading to the determination of the Boyle parameters. We also show that a similarity law, based on the Boyle parameters, yields accurate critical data when compared to the experiment. Furthermore, we show that the Boyle density scales linearly with the size-asymmetry, providing a direct route to establish a correspondence between the thermodynamic properties of different ionic compounds.

Progress in the Development of Direct Osmotic Concentration Wastewater Recovery Process for Advanced Life Support Systems

NASA Technical Reports Server (NTRS)

Cath, Tzahi Y.; Adams, Dean V.; Childress, Amy; Gormly, Sherwin; Flynn, Michael

2005-01-01

Direct osmotic concentration (DOC) has been identified as a high potential technology for recycling of wastewater to drinking water in advanced life support (ALS) systems. As a result the DOC process has been selected for a NASA Rapid Technology Development Team (RTDT) effort. The existing prototype system has been developed to a Technology Readiness Level (TRL) 3. The current project focuses on advancing the development of this technology from TRL 3 to TRL 6 (appropriate for human rated testing). A new prototype of a DOC system is been designed and fabricated that addresses the deficiencies encountered during the testing of the original system and allowing the new prototype to achieve TRL 6. Background information is provided about the technologies investigated and their capabilities, results from preliminary tests, and the milestones plan and activities for the RTDT program intended to develop a second generation prototype of the DOC system.

A simplified Mach number scaling law for helicopter rotor noise

NASA Technical Reports Server (NTRS)

Aravamudan, K. S.; Lee, A.; Harris, W. L.

1978-01-01

Mach number scaling laws are derived for the rotational and the high-frequency broadband noise from helicopter rotors. The rotational scaling law is obtained directly from the theory of Lowson and Ollerhead (1969) by exploiting the properties of the dominant terms in the expression for the complex Fourier coefficients of sound radiation from a point source. The scaling law for the high-frequency broadband noise is obtained by assuming that the noise sources are acoustically compact and computing the instantaneous pressure due to an element on an airfoil where vortices are shed. Experimental results on the correlation lengths for stationary airfoils are extended to rotating airfoils. On the assumption that the correlation length varies as the boundary layer displacement thickness, it is found that the Mach number scaling law contains a factor of Mach number raised to the exponent 5.8. Both scaling laws were verified by model tests.

Has the sanctity of life law ‘gone too far’?: analysis of the sanctity of life doctrine and English case law shows that the sanctity of life law has not ‘gone too far’

PubMed Central

2014-01-01

The medical profession consistently strives to uphold patient empowerment, equality and safety. It is ironic that now, at a time where advances in technology and knowledge have given us an increased capacity to preserve and prolong life, we find ourselves increasingly asking questions about the value of the lives we are saving. A recent editorial by Professor Raanan Gillon questions the emphasis that English law places on the sanctity of life doctrine. In what was described by Reverend Nick Donnelly as a “manifesto for killing patients”, Professor Gillon argues that the sanctity of life law has gone too far because of its disregard for distributive justice and an incompetent person’s previously declared autonomy. This review begins by outlining the stance of the sanctity of life doctrine on decisions about administering, withholding and withdrawing life-prolonging treatment. Using this as a foundation for a rebuttal, a proposal is made that Professor Gillon’s assertions do not take the following into account: 1) A sanctity of life law does not exist since English Common Law infringes the sanctity doctrine by tolerating quality of life judgements and a doctor’s intention to hasten death when withdrawing life-prolonging treatment. 2) Even if a true sanctity of life law did exist: a) The sanctity of life doctrine allows for resource considerations in the wider analysis of benefits and burdens. b) The sanctity of life doctrine yields to a competent person’s autonomous decision. This review attempts to demonstrate that at present, and with the legal precedent that restricts it, a sanctity of life law cannot go too far. PMID:24559151

Learning the Law: Law Education for Young North Carolinians.

ERIC Educational Resources Information Center

Edwards, Wanda Rushing; Carr, Edward G., Jr.

Arranged in five chapters, this supplementary resource for junior high students contains information on the history, practical applications, and social consequences of the law. In chapter 1, students are introduced to the origin of laws through examination of a fable, the relationship between government and laws, types of laws, and law…

Origin of Noncubic Scaling Law in Disordered Granular Packing

DOE Office of Scientific and Technical Information (OSTI.GOV)

Xia, Chengjie; Li, Jindong; Kou, Binquan

Recent diffraction experiments on metallic glasses have unveiled an unexpected non-cubic scaling law between density and average interatomic distance, which lead to the speculations on the presence of fractal glass order. Using X-ray tomography we identify here a similar non-cubic scaling law in disordered granular packing of spherical particles. We find that the scaling law is directly related to the contact neighbors within first nearest neighbor shell, and therefore is closely connected to the phenomenon of jamming. The seemingly universal scaling exponent around 2.5 arises due to the isostatic condition with contact number around 6, and we argue that themore » exponent should not be universal.« less

Fluctuating capacity and advance decision-making in Bipolar Affective Disorder — Self-binding directives and self-determination

PubMed Central

Gergel, Tania; Owen, Gareth S.

2015-01-01

For people with Bipolar Affective Disorder, a self-binding (advance) directive (SBD), by which they commit themselves to treatment during future episodes of mania, even if unwilling, can seem the most rational way to deal with an imperfect predicament. Knowing that mania will almost certainly cause enormous damage to themselves, their preferred solution may well be to allow trusted others to enforce treatment and constraint, traumatic though this may be. No adequate provision exists for drafting a truly effective SBD and efforts to establish such provision are hampered by very valid, but also paralysing ethical, clinical and legal concerns. Effectively, the autonomy and rights of people with bipolar are being ‘protected’ through being denied an opportunity to protect themselves. From a standpoint firmly rooted in the clinical context and experience of mania, this article argues that an SBD, based on a patient-centred evaluation of capacity to make treatment decisions (DMC-T) and grounded within the clinician–patient relationship, could represent a legitimate and ethically coherent form of self-determination. After setting out background information on fluctuating capacity, mania and advance directives, this article proposes a framework for constructing such an SBD, and considers common objections, possible solutions and suggestions for future research. PMID:25939286

Toward a physics-based rate and state friction law for earthquake nucleation processes in fault zones with granular gouge

NASA Astrophysics Data System (ADS)

Ferdowsi, B.; Rubin, A. M.

2017-12-01

Numerical simulations of earthquake nucleation rely on constitutive rate and state evolution laws to model earthquake initiation and propagation processes. The response of different state evolution laws to large velocity increases is an important feature of these constitutive relations that can significantly change the style of earthquake nucleation in numerical models. However, currently there is not a rigorous understanding of the physical origins of the response of bare rock or gouge-filled fault zones to large velocity increases. This in turn hinders our ability to design physics-based friction laws that can appropriately describe those responses. We here argue that most fault zones form a granular gouge after an initial shearing phase and that it is the behavior of the gouge layer that controls the fault friction. We perform numerical experiments of a confined sheared granular gouge under a range of confining stresses and driving velocities relevant to fault zones and apply 1-3 order of magnitude velocity steps to explore dynamical behavior of the system from grain- to macro-scales. We compare our numerical observations with experimental data from biaxial double-direct-shear fault gouge experiments under equivalent loading and driving conditions. Our intention is to first investigate the degree to which these numerical experiments, with Hertzian normal and Coulomb friction laws at the grain-grain contact scale and without any time-dependent plasticity, can reproduce experimental fault gouge behavior. We next compare the behavior observed in numerical experiments with predictions of the Dieterich (Aging) and Ruina (Slip) friction laws. Finally, the numerical observations at the grain and meso-scales will be used for designing a rate and state evolution law that takes into account recent advances in rheology of granular systems, including local and non-local effects, for a wide range of shear rates and slow and fast deformation regimes of the fault gouge.

Experimental Confirmation of Lenz's Law

ERIC Educational Resources Information Center

Mayer, V. V.; Varaksina, E. I.

2017-01-01

The paper presents a series of experiments that demonstrate the phenomenon of electromagnetic induction. These make it possible to determine the direction of the induced current and so confirm Lenz's Law. The simple experiments can be reproduced in a school laboratory and can be recommended for students' project activity.

Natural law and the "right to die".

PubMed

Whiting, R A

Over the last two decades social concerns with the "right to die" have grown beyond the ability of our governmental and judicial institutions to consistently deal with them. One reason for this difficulty has been the unavailability of any legal or judicial standard that is consistent with American conceptions of liberty, morality, and justice. This article attempts to examine the theory of natural law to determine whether it may provide a consistent standard for resolving these difficult questions. As natural law theories are traced through history, they lead directly to the United States where a uniquely American interpretation became one of the foundational principles for our constitution. By applying these theories to the contemporary question of the "right to die," natural law can again provide the foundational principles needed to develop standards for dealing with such questions that are consistent with our historical, philosophical, and political traditions.